Provider Demographics
NPI:1316922883
Name:HOROWITZ, MITCHELL L (MD)
Entity type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:L
Last Name:HOROWITZ
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 1:21 OTTOWA ROAD NORTH
Mailing Address - Street 2:
Mailing Address - City:MORGANVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07751
Mailing Address - Country:US
Mailing Address - Phone:732-915-0217
Mailing Address - Fax:732-970-4445
Practice Address - Street 1:21 OTTOWA ROAD NORTH
Practice Address - Street 2:
Practice Address - City:MORGANVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07751
Practice Address - Country:US
Practice Address - Phone:732-915-0217
Practice Address - Fax:732-970-4445
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-07
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY175344207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6523005Medicaid
NY01800499Medicaid
NYF75762Medicare UPIN
NY01800499Medicaid
NJ6523005Medicaid