Provider Demographics
NPI:1881958882
Name:KATZ, SOLOMON Y
Entity type:Individual
Prefix:
First Name:SOLOMON
Middle Name:Y
Last Name:KATZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1307 MOTT AVE
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-5123
Mailing Address - Country:US
Mailing Address - Phone:917-373-7347
Mailing Address - Fax:
Practice Address - Street 1:1307 MOTT AVE
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-5123
Practice Address - Country:US
Practice Address - Phone:917-373-7347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-25
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1371764174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1371764OtherUNIVERSITY OF THE STATE OF NEW YORK EDUCATION DEPARTMENT