Healthcare Provider Details

I. General information

NPI: 1912434911
Provider Name (Legal Business Name): JOHN B HORAK PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2017
Last Update Date: 06/25/2020
Certification Date: 06/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 SEYMOUR STREET HARTFORD HOSPITAL CARDIOLOGY DEPT
HARTFORD CT
06102-8000
US

IV. Provider business mailing address

80 SEYMOUR STREET HARTFORD HOSPITAL CARDIOLOGY DEPT
HARTFORD CT
06102-8000
US

V. Phone/Fax

Practice location:
  • Phone: 860-972-9495
  • Fax:
Mailing address:
  • Phone: 609-729-4958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number003848
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA6900
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: