Provider Demographics
NPI:1144522509
Name:ADIS, KATHARINE (RPAC)
Entity type:Individual
Prefix:MRS
First Name:KATHARINE
Middle Name:
Last Name:ADIS
Suffix:
Gender:F
Credentials:RPAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 SUTTON ST
Mailing Address - Street 2:APT PH
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11222-5142
Mailing Address - Country:US
Mailing Address - Phone:845-269-5072
Mailing Address - Fax:
Practice Address - Street 1:1315 YORK AVE
Practice Address - Street 2:MEZZANINE
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-5304
Practice Address - Country:US
Practice Address - Phone:212-746-5077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-17
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014248-1363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical