Provider Demographics
NPI:1306967211
Name:KATZURIN, SAM (MD)
Entity type:Individual
Prefix:DR
First Name:SAM
Middle Name:
Last Name:KATZURIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:11 STONY RUN RD
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11023-1923
Mailing Address - Country:US
Mailing Address - Phone:516-829-6449
Mailing Address - Fax:516-829-2539
Practice Address - Street 1:161 ATLANTIC AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-6720
Practice Address - Country:US
Practice Address - Phone:718-852-5232
Practice Address - Fax:718-596-9085
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY131528207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00374552Medicaid
NYA98929Medicare UPIN
NY08A111Medicare ID - Type Unspecified
NY00374552Medicaid