Katlin Davila
Individual provider Active NPI Specialist · South River, NJ
NPI 1124698345 · NPPES record last updated Jun 29, 2021
Key facts
- NPI
- 1124698345
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Specialist 174400000X
- License
- 1432276201 (NY)
- Practice address
- 79 Morningside Ave
South River, NJ 08882-2139 - Phone
- (718) 510-6813
- NPI assigned
- Jun 29, 2021
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1432276201 | NY | MD | Specialist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 1432276201 | NY | Yes |
Addresses
Primary practice location
79 Morningside Ave
South River, NJ 08882-2139
Mailing address
79 Morningside Ave
South River, NJ 08882-2139
Phone (718) 510-6813
Other providers in South River, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 29, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.