Provider Demographics
NPI:1477649853
Name:HOROWITZ, MARK L (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:L
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 1:10 RONALD REAGAN BLVD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:NY
Mailing Address - Zip Code:10990-4104
Mailing Address - Country:US
Mailing Address - Phone:845-986-2058
Mailing Address - Fax:845-986-7669
Practice Address - Street 1:10 RONALD REAGAN BLVD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:NY
Practice Address - Zip Code:10990-4104
Practice Address - Country:US
Practice Address - Phone:845-986-2058
Practice Address - Fax:845-986-7669
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY135749-1208000000X
NJ25MA06649400208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00513617Medicaid
NJ0283908Medicaid
NY00513617Medicaid
NYA400009580Medicare PIN