Provider Demographics
NPI:1114941507
Name:HORWITZ, LENORD SHYIA (DPM)
Entity Type:Individual
Prefix:DR
First Name:LENORD
Middle Name:SHYIA
Last Name:HORWITZ
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 FAWN CIRCLE
Mailing Address - Street 2:
Mailing Address - City:BLUEFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:24605
Mailing Address - Country:US
Mailing Address - Phone:276-322-3601
Mailing Address - Fax:276-322-2355
Practice Address - Street 1:2135 COLLEGE AVENUE
Practice Address - Street 2:
Practice Address - City:BLUEFIELD
Practice Address - State:VA
Practice Address - Zip Code:24605
Practice Address - Country:US
Practice Address - Phone:276-322-5039
Practice Address - Fax:276-322-5396
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103000951213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV009994600Medicaid
VA009302174Medicaid
VAA104357Medicare PIN
VA009302174Medicaid