Basic Information
| Provider Information | |||||||||
| NPI: | 1679697312 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MARK HOROWITZ MD PEDIATRIC UROLOGY PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1061 | ||||||||
| Address2: | |||||||||
| City: | GREAT NECK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182261271 | ||||||||
| FaxNumber: | 7182261247 | ||||||||
| Practice Location | |||||||||
| Address1: | 256 MASON AVE | ||||||||
| Address2: | |||||||||
| City: | STATEN ISLAND | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10305 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182261271 | ||||||||
| FaxNumber: | 7182261247 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/19/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | HOROWITZ | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7182261271 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | 60172766 | NY | X | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Urology | 2088P0231X | 60172766 | NY | X | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Urology | Pediatric Urology |
No ID Information.