Provider Demographics
NPI:1588846695
Name:HOROWITZ, RIVKA SIMA (MD)
Entity Type:Individual
Prefix:
First Name:RIVKA
Middle Name:SIMA
Last Name:HOROWITZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 MULBERRY LN
Mailing Address - Street 2:
Mailing Address - City:NIANTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06357-1255
Mailing Address - Country:US
Mailing Address - Phone:860-460-1720
Mailing Address - Fax:860-739-6019
Practice Address - Street 1:3 MULBERRY LN
Practice Address - Street 2:
Practice Address - City:NIANTIC
Practice Address - State:CT
Practice Address - Zip Code:06357-1255
Practice Address - Country:US
Practice Address - Phone:860-460-1720
Practice Address - Fax:860-739-6019
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-30
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT228822083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTE61702Medicare UPIN