Provider Demographics
NPI:1730359894
Name:ADAM M. KATOF, D.O., PLLC
Entity type:Organization
Organization Name:ADAM M. KATOF, D.O., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:KATOF
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:516-513-1720
Mailing Address - Street 1:100 MANETTO HILL ROAD
Mailing Address - Street 2:SUITE 312
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-1311
Mailing Address - Country:US
Mailing Address - Phone:516-513-1720
Mailing Address - Fax:516-513-1722
Practice Address - Street 1:100 MANETTO HILL ROAD
Practice Address - Street 2:SUITE 312
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-1311
Practice Address - Country:US
Practice Address - Phone:516-513-1720
Practice Address - Fax:516-513-1722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY218967207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02458868Medicaid
NY02458868Medicaid