Basic Information
| Provider Information | |||||||||
| NPI: | 1881885721 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | DORTZBACH | ||||||||
| FirstName: | KATHRYN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 550 | ||||||||
| Address2: | 2 CATHARINE STREET INFIRMARY ANESTHESIA ASSOCIATES LLP | ||||||||
| City: | POUGHKEEPSIE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 12602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8668688415 | ||||||||
| FaxNumber: | 8457902675 | ||||||||
| Practice Location | |||||||||
| Address1: | 310 E 14TH STREET | ||||||||
| Address2: | NY EYE & EAR INFIRMARY | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2129794000 | ||||||||
| FaxNumber: | 8457902675 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/06/2007 | ||||||||
| LastUpdateDate: | 11/19/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 2311011 | NY | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 02909199 | 05 | NY | MEDICAID |