Provider Demographics
NPI:1699730580
Name:HORN, KELLY (DO)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:
Last Name:HORN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:60 MADISON AVE FL 5
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-1600
Mailing Address - Country:US
Mailing Address - Phone:212-545-2439
Mailing Address - Fax:646-312-0481
Practice Address - Street 1:90-04 161ST STREET
Practice Address - Street 2:5TH FLOOR
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-6103
Practice Address - Country:US
Practice Address - Phone:718-523-2123
Practice Address - Fax:718-523-5833
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY234578207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02674317Medicaid