Healthcare Provider Details

I. General information

NPI: 1104137785
Provider Name (Legal Business Name): ROBERT JOHN HORN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2010
Last Update Date: 11/07/2023
Certification Date: 11/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE MEDICAL CENTER DRIVE UMDNJ-SOM
STRATFORD NJ
08084
US

IV. Provider business mailing address

921 ADAMS AVE
LANGHORNE PA
19047-5432
US

V. Phone/Fax

Practice location:
  • Phone: 856-566-6708
  • Fax:
Mailing address:
  • Phone: 267-918-3782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberOS017144
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: