Provider Demographics
NPI:1275647174
Name:HOROWITZ, MICHAEL SIDNEY (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:SIDNEY
Last Name:HOROWITZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:253 TRINIDAD DR
Mailing Address - Street 2:
Mailing Address - City:TIBURON
Mailing Address - State:CA
Mailing Address - Zip Code:94920-1039
Mailing Address - Country:US
Mailing Address - Phone:201-563-2205
Mailing Address - Fax:415-797-6065
Practice Address - Street 1:253 TRINIDAD DR
Practice Address - Street 2:
Practice Address - City:TIBURON
Practice Address - State:CA
Practice Address - Zip Code:94920-1039
Practice Address - Country:US
Practice Address - Phone:201-563-2205
Practice Address - Fax:973-364-0101
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG22771207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJD77304Medicare UPIN
NJ657692Medicare ID - Type Unspecified