=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992063002
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARILYN HORVATH MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/26/2012
-----------------------------------------------------
Last Update Date | 04/26/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4317 SW 186TH AVE
-----------------------------------------------------
City | MIRAMAR
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33029-2772
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-553-3955
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 824437
-----------------------------------------------------
City | PEMBROKE PINES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33082-4437
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-553-3955
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MARILYN HORVATH
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 786-553-3955
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0805X
-----------------------------------------------------
Taxonomy Name | Geriatric Psychiatry Physician
-----------------------------------------------------
License Number | ME96932
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------