Provider Demographics
NPI:1841334810
Name:HORWITZ, LEORA IDIT (MD, MHS)
Entity type:Individual
Prefix:DR
First Name:LEORA
Middle Name:IDIT
Last Name:HORWITZ
Suffix:
Gender:F
Credentials:MD, MHS
Other - Prefix:MRS
Other - First Name:LEORA
Other - Middle Name:HORWITZ
Other - Last Name:KAUFMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:550 1ST AVE
Mailing Address - Street 2:TRB ROOM 607
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-6402
Mailing Address - Country:US
Mailing Address - Phone:646-501-2685
Mailing Address - Fax:646-501-2706
Practice Address - Street 1:550 1ST AVE
Practice Address - Street 2:TRB ROOM 607
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6402
Practice Address - Country:US
Practice Address - Phone:646-501-2685
Practice Address - Fax:646-501-2706
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT042642207R00000X
NY221998207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H87435Medicare UPIN
110010456Medicare PIN