Healthcare Provider Details

I. General information

NPI: 1821095605
Provider Name (Legal Business Name): CHRISTOPHER M HORN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 12/10/2021
Certification Date: 12/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 EAST MAIN STREET
ROCKAWAY NJ
07866
US

IV. Provider business mailing address

404 LIPPINCOTT DR
MARLTON NJ
08053-4112
US

V. Phone/Fax

Practice location:
  • Phone: 973-627-4499
  • Fax: 973-627-5083
Mailing address:
  • Phone: 856-782-3300
  • Fax: 856-504-8029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number200100701
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMB06972800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: