MEDICARE: DR. LEE MARSHALL HOROWITZ M.D.

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	2085R0202X	Diagnostic Radiology Physician	125957	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	177-137-7	OTHER	NY	ECFMG
2	125957	OTHER	NY	LICENSE

General Provider Information

NPI Number	:	1679609457
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEE MARSHALL HOROWITZ M.D.

Provider Business Mailing Address
First Line	:	23 TECHNOLOGY DR
Second Line	:
City	:	EAST SETAUKET
State	:	NY
Zip	:	11733-4075
Country	:	US
Telephone Number	:	631-689-7300
Fax Number	:	631-689-7321

Provider Business Practice Location Address
First Line	:	23 TECHNOLOGY DR
Second Line	:
City	:	EAST SETAUKET
State	:	NY
Zip	:	11733-4075
Country	:	US
Telephone Number	:	631-689-7300
Fax Number	:	631-689-7321

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/26/2007
Last Update Date	:	07/08/2007

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