Provider Demographics
NPI:1316924772
Name:HORKHEIMER, IAN C (MD)
Entity type:Individual
Prefix:
First Name:IAN
Middle Name:C
Last Name:HORKHEIMER
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 1:180 WHITE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LITTLE SILVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07739-1166
Mailing Address - Country:US
Mailing Address - Phone:732-530-8666
Mailing Address - Fax:732-530-4139
Practice Address - Street 1:180 WHITE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:LITTLE SILVER
Practice Address - State:NJ
Practice Address - Zip Code:07739-1166
Practice Address - Country:US
Practice Address - Phone:732-530-8666
Practice Address - Fax:732-530-4139
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08068100174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
BH7355236OtherDEA
H61946Medicare UPIN