Provider Demographics
NPI:1053351106
Name:KATZ, DORON Z (MD)
Entity type:Individual
Prefix:DR
First Name:DORON
Middle Name:Z
Last Name:KATZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:177 N DEAN ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-2533
Mailing Address - Country:US
Mailing Address - Phone:201-503-0833
Mailing Address - Fax:201-503-0844
Practice Address - Street 1:177 N DEAN ST
Practice Address - Street 2:SUITE 203
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-2533
Practice Address - Country:US
Practice Address - Phone:201-503-0833
Practice Address - Fax:201-503-0844
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY232225207R00000X
NJMA07781500207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01421705Medicaid
NYI24920Medicare UPIN
NJ090454Medicare PIN
NY01421705Medicaid