Healthcare Provider Details

I. General information

NPI: 1417925017
Provider Name (Legal Business Name): GARY R HOROWITZ DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 10/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5401 OLD YORK RD SUITE 300
PHILADELPHIA PA
19141
US

IV. Provider business mailing address

101 E OLNEY AVE SUITE 400
PHILADELPHIA PA
19120
US

V. Phone/Fax

Practice location:
  • Phone: 215-456-7190
  • Fax:
Mailing address:
  • Phone: 215-456-7000
  • Fax: 215-254-2599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberOS002910L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: