Provider Demographics
NPI:1053498147
Name:HORWICH, PERRY JAY (MD)
Entity Type:Individual
Prefix:DR
First Name:PERRY
Middle Name:JAY
Last Name:HORWICH
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 1:2020 PALOMINO LANE
Mailing Address - Street 2:STE # 100
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4894
Mailing Address - Country:US
Mailing Address - Phone:702-759-8600
Mailing Address - Fax:702-384-1815
Practice Address - Street 1:2020 PALOMINO LANE
Practice Address - Street 2:STE # 100
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4894
Practice Address - Country:US
Practice Address - Phone:702-759-8600
Practice Address - Fax:702-384-1815
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2135462085R0202X
NY216852-12085R0202X
NV162212085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVP01618135OtherRR MEDICARE DR
MA2043513Medicaid
NY03349075Medicaid
NVP01645281OtherRR MEDICARE DRS
NV1053498147Medicaid
NVV112314Medicare PIN
NVP01645281OtherRR MEDICARE DRS
NV1053498147Medicaid
NYJ400047626Medicare PIN
MA2043513Medicaid