MEDICARE: KENNETH HOROWITZ OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist

General Provider Information

NPI Number	:	1487890554
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KENNETH HOROWITZ OD

Provider Business Mailing Address
First Line	:	927 WILLOWBROOK RD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314
Country	:	US
Telephone Number	:	718-982-8790
Fax Number	:	718-982-9366

Provider Business Practice Location Address
First Line	:	927 WILLOWBROOK RD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-4274
Country	:	US
Telephone Number	:	718-982-8790
Fax Number	:	718-982-9366

Authorized Official
Title or Position	:	DR
Name	:	KENNETH HOROWITZ
Credential	:	O.D.
Telephone Number	:	718-982-8790

Provider Enumeration Date	:	12/19/2008
Last Update Date	:	12/19/2008

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