Provider Demographics
NPI:1750684007
Name:HORIZON SUBSPECIALTIES INC
Entity Type:Organization
Organization Name:HORIZON SUBSPECIALTIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:F
Authorized Official - Last Name:GRODEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-961-2403
Mailing Address - Street 1:81 HAWTHORN ST # R
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02740-3429
Mailing Address - Country:US
Mailing Address - Phone:508-961-2403
Mailing Address - Fax:
Practice Address - Street 1:81 HAWTHORN ST # R
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-3429
Practice Address - Country:US
Practice Address - Phone:508-961-2403
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-08
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA719612080P0202X, 2080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric CardiologyGroup - Multi-Specialty
No2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric GastroenterologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3074013Medicaid
MAJ10696Medicare PIN
MA3074013Medicaid