Provider Demographics
NPI:1235461260
Name:J.B.KATZ-GERRISH, DO, PC
Entity type:Organization
Organization Name:J.B.KATZ-GERRISH, DO, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:B
Authorized Official - Last Name:KATZ-GERRISH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:845-627-1050
Mailing Address - Street 1:40 ROSE RD
Mailing Address - Street 2:
Mailing Address - City:WEST NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10994-2116
Mailing Address - Country:US
Mailing Address - Phone:845-627-1050
Mailing Address - Fax:845-624-4808
Practice Address - Street 1:40 ROSE RD
Practice Address - Street 2:
Practice Address - City:WEST NYACK
Practice Address - State:NY
Practice Address - Zip Code:10994-2116
Practice Address - Country:US
Practice Address - Phone:845-627-1050
Practice Address - Fax:845-624-4808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-01
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY203619207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G31678Medicare UPIN
9X3371Medicare PIN