Provider Demographics
NPI:1124007133
Name:HOROWITZ, BRUCE R (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:R
Last Name:HOROWITZ
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 1:222 STATION PLAZA NORTH
Mailing Address - Street 2:SUITE 310
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501
Mailing Address - Country:US
Mailing Address - Phone:516-663-3822
Mailing Address - Fax:516-663-4740
Practice Address - Street 1:222 STATION PLAZA NORTH
Practice Address - Street 2:SUITE 310
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501
Practice Address - Country:US
Practice Address - Phone:516-663-2051
Practice Address - Fax:516-663-4740
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNYS 155239207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
431649NOtherCIGNA
441013OtherUNITED HEALTHCARE
4454799OtherAETNA
96D681OtherBC BS
NY01023243Medicaid
OC6397OtherHEALTHNET
1307772OtherFIRSTHEALTH
186OtherVYTRA
2500237OtherGHI
AP796OtherOXFORD
NY01023243Medicaid
441013OtherUNITED HEALTHCARE