Provider Demographics
NPI:1508970658
Name:HORN, LAWRENCE A (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:A
Last Name:HORN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:202 E MAIN ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-2993
Mailing Address - Country:US
Mailing Address - Phone:631-271-4330
Mailing Address - Fax:631-271-4213
Practice Address - Street 1:202 E MAIN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-2993
Practice Address - Country:US
Practice Address - Phone:631-271-4330
Practice Address - Fax:631-271-4213
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY116711207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00491685Medicaid
NYC07921Medicare UPIN
NY00491685Medicaid