Healthcare Provider Details

I. General information

NPI: 1114030616
Provider Name (Legal Business Name): ROBERT HAROLD HOROWITZ D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

422 FAIRVIEW AVE
COLONIA NJ
07067-3717
US

IV. Provider business mailing address

422 FAIRVIEW AVE
COLONIA NJ
07067-3717
US

V. Phone/Fax

Practice location:
  • Phone: 732-381-7171
  • Fax: 732-499-9830
Mailing address:
  • Phone: 732-381-7171
  • Fax: 732-499-9830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number22DI00970600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: