Provider Demographics
NPI:1679609457
Name:HOROWITZ, LEE MARSHALL (MD)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:MARSHALL
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 1:23 TECHNOLOGY DR
Mailing Address - Street 2:
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-4075
Mailing Address - Country:US
Mailing Address - Phone:631-689-7300
Mailing Address - Fax:631-689-7321
Practice Address - Street 1:23 TECHNOLOGY DR
Practice Address - Street 2:
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-4075
Practice Address - Country:US
Practice Address - Phone:631-689-7300
Practice Address - Fax:631-689-7321
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1259572085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY177-137-7OtherECFMG
NY125957OtherLICENSE
NYC06991Medicare UPIN