Provider Demographics
NPI:1366426504
Name:HOROWITZ, KENNETH J (OD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:J
Last Name:HOROWITZ
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:612 CORPORATE WAY
Mailing Address - Street 2:STE 2M
Mailing Address - City:VALLEY COTTAGE
Mailing Address - State:NY
Mailing Address - Zip Code:10989-2027
Mailing Address - Country:US
Mailing Address - Phone:718-982-8790
Mailing Address - Fax:718-982-9366
Practice Address - Street 1:15 CANAL RD
Practice Address - Street 2:
Practice Address - City:PELHAM
Practice Address - State:NY
Practice Address - Zip Code:10803-2706
Practice Address - Country:US
Practice Address - Phone:718-982-8790
Practice Address - Fax:718-982-9366
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-01
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY003008-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00339551Medicaid
NYT81438Medicare UPIN
NY0177420001Medicare NSC
NY00339551Medicaid