Provider Demographics
NPI:1922171602
Name:HORN, EVELYN MIRIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:EVELYN
Middle Name:MIRIAM
Last Name:HORN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 E 70TH ST
Mailing Address - Street 2:STARR 4
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-9800
Mailing Address - Country:US
Mailing Address - Phone:212-746-2381
Mailing Address - Fax:212-746-6665
Practice Address - Street 1:520 E 70TH ST
Practice Address - Street 2:STARR 4
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-9800
Practice Address - Country:US
Practice Address - Phone:212-746-2381
Practice Address - Fax:212-746-6665
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2017-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY147231207RC0000X, 207RA0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0001XAllopathic & Osteopathic PhysiciansInternal MedicineAdvanced Heart Failure and Transplant Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00930369Medicaid
NYC11524Medicare UPIN
NY60D231Medicare ID - Type Unspecified