Healthcare Provider Details

I. General information

NPI: 1376581108
Provider Name (Legal Business Name): JEROME HOWARD HOROWITZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 08/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2217 BRISTOL PIKE
BENSALEM PA
19020-5720
US

IV. Provider business mailing address

2217 BRISTOL PIKE
BENSALEM PA
19020-5720
US

V. Phone/Fax

Practice location:
  • Phone: 215-638-0555
  • Fax: 215-638-2929
Mailing address:
  • Phone: 215-638-0555
  • Fax: 215-638-2929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD007736E
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: