Provider Demographics
NPI:1790753820
Name:HOROWITZ, LAWRENCE MORTON (DO)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:MORTON
Last Name:HOROWITZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:99 E STATE ST
Mailing Address - Street 2:PO BOX 1250
Mailing Address - City:GLOVERSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12078-1203
Mailing Address - Country:US
Mailing Address - Phone:518-773-7520
Mailing Address - Fax:518-773-4629
Practice Address - Street 1:182 STEELE AVE
Practice Address - Street 2:
Practice Address - City:GLOVERSVILLE
Practice Address - State:NY
Practice Address - Zip Code:12078-4617
Practice Address - Country:US
Practice Address - Phone:518-773-7520
Practice Address - Fax:518-773-4629
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY107731208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY10000919OtherCDPHP HMO
NY00542301Medicaid
NY701611OtherEMPIRE BLUE CROSS
NY000025017OtherBLUE SHIELD NORTH EAST
Y021751OtherCHAMPUS
NY26125OtherMVP HMO
NY10000919OtherCDPHP HMO