1891776084 NPI number — DR. EDWARD KATIME M.D.

Table of content: DR. EDWARD KATIME M.D. (NPI 1891776084)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891776084 NPI number — DR. EDWARD KATIME M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KATIME
Provider First Name:
EDWARD
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1891776084
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/11/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
877 STEWART AVE
Provider Second Line Business Mailing Address:
SUITE 8
Provider Business Mailing Address City Name:
GARDEN CITY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11530-4803
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-222-1616
Provider Business Mailing Address Fax Number:
516-222-0437

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
877 STEWART AVE
Provider Second Line Business Practice Location Address:
SUITE 8
Provider Business Practice Location Address City Name:
GARDEN CITY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11530-4803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-222-1616
Provider Business Practice Location Address Fax Number:
516-222-0437
Provider Enumeration Date:
11/07/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  143976 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 04001367 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 131154 . This is a "GREAT WEST ONE HEALTH PLA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 65A311 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: OC6302 . This is a "HEALTH NET INSURANCE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00946263 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10-00001 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: AL46518 . This is a "MDNY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: AS1107 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 449 . This is a "VYTRA HEALTH PLANS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 53593 . This is a "GHI HMO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0061915 . This is a "GHI INSURANCE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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