Provider Demographics
NPI:1912965435
Name:HORNE, NATHANAEL SUN (MD)
Entity type:Individual
Prefix:
First Name:NATHANAEL
Middle Name:SUN
Last Name:HORNE
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 1:355 W 52ND ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-6239
Mailing Address - Country:US
Mailing Address - Phone:646-754-2100
Mailing Address - Fax:646-754-2115
Practice Address - Street 1:355 W 52ND ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-6239
Practice Address - Country:US
Practice Address - Phone:646-754-2100
Practice Address - Fax:646-754-2115
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY228065207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYI48274Medicare UPIN
NYWEZ121Medicare ID - Type UnspecifiedGROUP NUMBER
NYY48505Medicare UPIN
NY356AK1Medicare ID - Type UnspecifiedINDIVIDUAL