Provider Demographics
NPI:1003803875
Name:HORN, MICHAEL D (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:D
Last Name:HORN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 SALEM RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:WILLINGBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08046-2852
Mailing Address - Country:US
Mailing Address - Phone:609-871-2060
Mailing Address - Fax:609-871-3535
Practice Address - Street 1:1000 SALEM RD
Practice Address - Street 2:SUITE B
Practice Address - City:WILLINGBORO
Practice Address - State:NJ
Practice Address - Zip Code:08046-2852
Practice Address - Country:US
Practice Address - Phone:609-871-2060
Practice Address - Fax:609-871-3535
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA27438207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0327603Medicaid
D07034Medicare UPIN
087592BBVMedicare ID - Type Unspecified