Healthcare Provider Details

I. General information

NPI: 1992847222
Provider Name (Legal Business Name): ELLIOTT M HOROWITZ RD, CSCS, CES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 12/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12030 KEMPS LANDING CIR
MANASSAS VA
20109-4838
US

IV. Provider business mailing address

12030 KEMPS LANDING CIR
MANASSAS VA
20109-4838
US

V. Phone/Fax

Practice location:
  • Phone: 703-622-2321
  • Fax:
Mailing address:
  • Phone: 703-622-2321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: