Basic Information
| Provider Information | |||||||||
| NPI: | 1427284892 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOUGH | ||||||||
| FirstName: | KATIE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 715 ROANOKE AVE | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | RIVERHEAD | ||||||||
| State: | NY | ||||||||
| PostalCode: | 119012769 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6319634770 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 11700 MAIN RD | ||||||||
| Address2: | |||||||||
| City: | MATTITUCK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 119521525 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6316355440 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/29/2009 | ||||||||
| LastUpdateDate: | 03/03/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | OS11711 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 276692-1 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.