Provider Demographics
NPI:1831195320
Name:KATZ, JEFFREY IVAN (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:IVAN
Last Name:KATZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 E NORTHFIELD RD
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-4896
Mailing Address - Country:US
Mailing Address - Phone:973-436-1070
Mailing Address - Fax:
Practice Address - Street 1:315 E NORTHFIELD RD
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-4896
Practice Address - Country:US
Practice Address - Phone:973-436-1070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA031806208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D96965Medicare UPIN
148985AYTMedicare ID - Type Unspecified