Provider Demographics
NPI:1821006677
Name:HORN, ANSELL THEODORE (NP)
Entity type:Individual
Prefix:MR
First Name:ANSELL
Middle Name:THEODORE
Last Name:HORN
Suffix:
Gender:M
Credentials:NP
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:300 SKILLMAN AVE
Mailing Address - Street 2:LUTHERAN FHC -COMMUNITY MEDICINE
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-1607
Mailing Address - Country:US
Mailing Address - Phone:718-302-7366
Mailing Address - Fax:718-963-4016
Practice Address - Street 1:300 SKILLMAN AVE
Practice Address - Street 2:LUTHERAN FHC -COMMUNITY MEDICINE
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-1607
Practice Address - Country:US
Practice Address - Phone:718-302-7366
Practice Address - Fax:718-963-4016
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYF333304363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02744136Medicaid
15444G1Medicare UPIN