Provider Demographics
NPI:1669585089
Name:HORLICK, HOWARD P (MD)
Entity type:Individual
Prefix:
First Name:HOWARD
Middle Name:P
Last Name:HORLICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 FROEHLICH FARM BLVD
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11797
Mailing Address - Country:US
Mailing Address - Phone:516-921-2294
Mailing Address - Fax:516-921-1206
Practice Address - Street 1:169 FROEHLICH FARM BLVD
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NY
Practice Address - Zip Code:11797
Practice Address - Country:US
Practice Address - Phone:516-921-2294
Practice Address - Fax:516-921-1206
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY16311207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1518173897Medicare NSC
NY2K7652Medicare ID - Type Unspecified
A61596Medicare UPIN
NYW39421Medicare PIN
NYW39422Medicare PIN