Basic Information
Provider Information | |||||||||
NPI: | 1285746289 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | HORWITZ | ||||||||
FirstName: | JEFFREY | ||||||||
MiddleName: | ALANSON | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 301 W 1ST ST | ||||||||
Address2: | SUITE 3A | ||||||||
City: | DAYTON | ||||||||
State: | OH | ||||||||
PostalCode: | 454023033 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9372285015 | ||||||||
FaxNumber: | 9372285971 | ||||||||
Practice Location | |||||||||
Address1: | 301 W 1ST ST | ||||||||
Address2: | SUITE 3A | ||||||||
City: | DAYTON | ||||||||
State: | OH | ||||||||
PostalCode: | 454023033 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9372285015 | ||||||||
FaxNumber: | 9372285971 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/31/2006 | ||||||||
LastUpdateDate: | 07/09/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 35.030036 | OH | Y |   | Allopathic & Osteopathic Physicians | Ophthalmology |   |
ID Information
ID | Type | State | Issuer | Description | 50184 | 01 | OH | CIGNA | OTHER | 0218044 | 05 | OH |   | MEDICAID | D30036 | 01 | OH | HUMANA | OTHER | 0820105 | 01 | OH | UNITED HEALTHCARE | OTHER | 4256470 | 01 | OH | AETNA PIN | OTHER | 000000006864 | 01 | OH | ANTHEM BC & BS PIN | OTHER | 1147218 | 01 | OH | UMWA | OTHER |