Provider Demographics
NPI:1881744779
Name:KATSEV, MARIA (OD)
Entity type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:
Last Name:KATSEV
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2103 RALPH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-5405
Mailing Address - Country:US
Mailing Address - Phone:718-241-0400
Mailing Address - Fax:718-968-6854
Practice Address - Street 1:2103 RALPH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-5405
Practice Address - Country:US
Practice Address - Phone:718-241-0400
Practice Address - Fax:718-968-6854
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV06380152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02334898Medicaid
NY02334898Medicaid
C184F10Medicare PIN