1295927739 NPI number — DR. ANDREA KATZ M.D.

Table of content: DR. ANDREA KATZ M.D. (NPI 1295927739)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295927739 NPI number — DR. ANDREA KATZ M.D.

Organization/Personal Information

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

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ROSENBERG
Provider Other First Name:
ANDREA
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1295927739
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/08/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 102222
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30368-2222
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
392-748-2002
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
401 PALMETTO ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW SMYRNA BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32168-7322
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
386-424-5038
Provider Business Practice Location Address Fax Number:
386-424-5081
Provider Enumeration Date:
08/17/2007

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: 207RX0202X , with the licence number:  ME113573 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 9420727 . This is a "AETNA KEY WEST" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: P1052209 . This is a "FREEDOM JUPITER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 14LR5 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 9420727 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: GN848V . This is a "MEDICARE - KEY WEST" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: P984360 . This is a "OPTIMUM JUPITER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: GN848W . This is a "MEDICARE - JUPITER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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