Healthcare Provider Details

I. General information

NPI: 1104329622
Provider Name (Legal Business Name): LYNN HOROWITZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2018
Last Update Date: 03/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

STONY BROOK SCHOOL OF DENTAL MEDICINE 151 WESTCHESTER HALL
STONY BROOK NY
11794
US

IV. Provider business mailing address

STONY BROOK SCHOOL OF DENTAL MEDICINE 151 WESTCHESTER HALL
STONY BROOK NY
11794
US

V. Phone/Fax

Practice location:
  • Phone: 631-444-2557
  • Fax:
Mailing address:
  • Phone: 631-444-2557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: