Provider Demographics
NPI:1881885721
Name:DORTZBACH, KATHRYN (MD)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:DORTZBACH
Suffix:
Gender:F
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:PO BOX 550
Mailing Address - Street 2:2 CATHARINE STREET INFIRMARY ANESTHESIA ASSOCIATES LLP
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12602
Mailing Address - Country:US
Mailing Address - Phone:866-868-8415
Mailing Address - Fax:845-790-2675
Practice Address - Street 1:310 E 14TH STREET
Practice Address - Street 2:NY EYE & EAR INFIRMARY
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003
Practice Address - Country:US
Practice Address - Phone:212-979-4000
Practice Address - Fax:845-790-2675
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2311011207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02909199Medicaid
NYA400003480Medicare PIN
NY54669LL431Medicare PIN