Provider Demographics
NPI:1952391781
Name:HORTH, DANIEL (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:HORTH
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 1:34 CHENANGO AVE
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NY
Mailing Address - Zip Code:13323-1341
Mailing Address - Country:US
Mailing Address - Phone:315-853-5550
Mailing Address - Fax:315-853-5580
Practice Address - Street 1:34 CHENANGO AVE
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NY
Practice Address - Zip Code:13323-1341
Practice Address - Country:US
Practice Address - Phone:315-853-5550
Practice Address - Fax:315-853-5580
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY216809-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02065112Medicaid
NY08015666OtherRAILROAD MEDICARE
NYF54179Medicare UPIN
NY02065112Medicaid