Provider Demographics
NPI:1922093376
Name:HORNG, JACK W (MD)
Entity Type:Individual
Prefix:
First Name:JACK
Middle Name:W
Last Name:HORNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:20 GRAND ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:WARWICK
Mailing Address - State:NY
Mailing Address - Zip Code:10990-1035
Mailing Address - Country:US
Mailing Address - Phone:845-987-3906
Mailing Address - Fax:845-987-5979
Practice Address - Street 1:2 CROSFIELD AVE
Practice Address - Street 2:SUITE 318
Practice Address - City:WEST NYACK
Practice Address - State:NY
Practice Address - Zip Code:10994-2226
Practice Address - Country:US
Practice Address - Phone:845-353-5600
Practice Address - Fax:845-353-5668
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY2063691207RC0200X, 207RP1001X
NY206369207RS0012X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02155053Medicaid
132995699OtherHEATLH NOW
0D2071OtherHEALTHNET OF THE NORTHEAS
132995699OtherFAM HEALTH PLUS
132995699OtherHUDSON HEALTH PLAN MCD
2596421OtherGHI ALL PLANS EXCEPT HMO
33353POtherHIP
7588161OtherAETNA
132995599OtherCIGNA PPO
132995699OtherBEECH STREET NETWORK
132995699OtherFEDELIS MEDICAID HMO
132995699OtherHORIZON HEALTHCARE OF NY
1C4591OtherBCBS EMPIRE
132995699OtherMAGNACARE PPO
2522147OtherAETNA USHC
132995699OtherINDECS ORANGE ULSTER SCHL
132995699OtherLOCAL 1199
0053968OtherGHI HMO
132995699OtherMAGNACARE PPO
H16566Medicare UPIN