Provider Demographics
NPI:1902835507
Name:HORNICK, LAWRENCE (DO)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:
Last Name:HORNICK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 W JERICHO TPKE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-6362
Mailing Address - Country:US
Mailing Address - Phone:631-423-5400
Mailing Address - Fax:631-423-5423
Practice Address - Street 1:365 W JERICHO TPKE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-6362
Practice Address - Country:US
Practice Address - Phone:631-423-5400
Practice Address - Fax:631-423-5423
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY075646207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY494241Medicare ID - Type Unspecified
NYE34177Medicare UPIN