1023094612 NPI number — MARTIN I HOROWITZ M.D.

Table of content: MARTIN I HOROWITZ M.D. (NPI 1023094612)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023094612 NPI number — MARTIN I HOROWITZ M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOROWITZ
Provider First Name:
MARTIN
Provider Middle Name:
I
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023094612
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
147 MILK STREET
Provider Second Line Business Mailing Address:
9TH FLOOR, HARVARD VANGUARD MEDICAL ASSOCIATES
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02109-4862
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-559-8053
Provider Business Mailing Address Fax Number:
617-421-3487

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20 WALL ST
Provider Second Line Business Practice Location Address:
HARVARD VANGUARD MEDICAL ASSOCIATES
Provider Business Practice Location Address City Name:
BURLINGTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01803-4758
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-221-2500
Provider Business Practice Location Address Fax Number:
781-221-2510
Provider Enumeration Date:
12/16/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  58201 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: B10467002 . This is a "CIGNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 12-04574 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0140759 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 058201 . This is a "TUFTS HEALTH CARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: C21027 . This is a "BLUE CROSS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 3547318 . This is a "AETNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: PP130 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0015118 . This is a "NEIGHBORHOOD HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com