Provider Demographics
NPI:1861746174
Name:AUSTIN, KATHERINE (MD)
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1485 5TH AVE
Mailing Address - Street 2:22B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10035-2772
Mailing Address - Country:US
Mailing Address - Phone:917-261-7785
Mailing Address - Fax:
Practice Address - Street 1:1485 5TH AVE
Practice Address - Street 2:22B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-2772
Practice Address - Country:US
Practice Address - Phone:917-261-7785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-08
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY263767208000000X, 2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics