Basic Information
Provider Information
NPI: 1700805447
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HORWITZ
FirstName: RALPH
MiddleName: I
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2450 W HUNTING PARK AVE
Address2:  
City: PHILADELPHIA
State: PA
PostalCode: 191291302
CountryCode: US
TelephoneNumber: 2157071800
FaxNumber: 2157073644
Practice Location
Address1: 3322 N BROAD ST
Address2:  
City: PHILADELPHIA
State: PA
PostalCode: 191405185
CountryCode: US
TelephoneNumber: 2157071800
FaxNumber: 2157073644
Other Information
ProviderEnumerationDate: 07/19/2006
LastUpdateDate: 03/28/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XMD443614PAY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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