Provider Demographics
NPI:1679617179
Name:HOROWITZ, MARINA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARINA
Middle Name:
Last Name:HOROWITZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:332 PENINSULA BLVD APT A
Mailing Address - Street 2:
Mailing Address - City:CEDARHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11516-1155
Mailing Address - Country:US
Mailing Address - Phone:718-249-9838
Mailing Address - Fax:546-569-6264
Practice Address - Street 1:332 PENINSULA BLVD APT A
Practice Address - Street 2:
Practice Address - City:CEDARHURST
Practice Address - State:NY
Practice Address - Zip Code:11516-1155
Practice Address - Country:US
Practice Address - Phone:718-249-9838
Practice Address - Fax:546-569-6264
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY38295122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00825732Medicaid