Healthcare Provider Details

I. General information

NPI: 1275647174
Provider Name (Legal Business Name): MICHAEL SIDNEY HOROWITZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 10/14/2024
Certification Date: 10/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

253 TRINIDAD DR
TIBURON CA
94920-1039
US

IV. Provider business mailing address

253 TRINIDAD DR
TIBURON CA
94920-1039
US

V. Phone/Fax

Practice location:
  • Phone: 201-563-2205
  • Fax: 973-364-0101
Mailing address:
  • Phone: 201-563-2205
  • Fax: 415-797-6065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberG22771
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: