Provider Demographics
NPI:1083638704
Name:HORN, HARVEY RONALD (MD)
Entity Type:Individual
Prefix:DR
First Name:HARVEY
Middle Name:RONALD
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 1:419 ROBINSON AVENUE
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-3337
Mailing Address - Country:US
Mailing Address - Phone:845-562-2277
Mailing Address - Fax:845-562-8746
Practice Address - Street 1:419 ROBINSON AVENUE
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-3337
Practice Address - Country:US
Practice Address - Phone:845-562-2277
Practice Address - Fax:845-562-8746
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY142192208600000X, 208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00897681Medicaid
NYA63394Medicare UPIN
NY59D17ZXXP1Medicare PIN
NY00897681Medicaid