1568837409 NPI number — DR. ELISHEVA RENA KATZ PSY.D.

Table of content: DR. ELISHEVA RENA KATZ PSY.D. (NPI 1568837409)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568837409 NPI number — DR. ELISHEVA RENA KATZ PSY.D.

Organization/Personal Information

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

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
UNGAR
Provider Other First Name:
ELISHEVA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1568837409
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/15/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
142 VAN HOUTEN AVE APT 1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PASSAIC
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07055-4602
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-316-6592
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 HAMASPIK WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONROE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10950-8451
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-655-0600
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/03/2015

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: 103TS0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103T00000X , with the licence number: 022597 , 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: 022597 . This is a "LICENSURE NUMBER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 05237527 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1407211 . This is a "UNIVERSITY OF THE STATE OF NEW YORK: EDUCATION DEPARTMENT" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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