Healthcare Provider Details

I. General information

NPI: 1629619846
Provider Name (Legal Business Name): DANIEL A HORTON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2019
Last Update Date: 09/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 EVERETT RD
ALBANY NY
12205-1407
US

IV. Provider business mailing address

123 EVERETT RD
ALBANY NY
12205-1407
US

V. Phone/Fax

Practice location:
  • Phone: 518-701-2000
  • Fax: 518-701-2139
Mailing address:
  • Phone: 518-701-2000
  • Fax: 518-701-2139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number024076-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: