1124471685 NPI number — BENJAMIN HORN D.O.

Table of content: BENJAMIN HORN D.O. (NPI 1124471685)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124471685 NPI number — BENJAMIN HORN D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HORN
Provider First Name:
BENJAMIN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124471685
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5501 OLD YORK ROAD
Provider Second Line Business Mailing Address:
ALBERT EINSTEIN MEDICAL CENTER
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19141
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-456-6500
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15 ROCHE BROTHERS WAY STE 110
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH EASTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02356-1000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-792-6500
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/20/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  OS019927 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 390200000X , with the licence number: OT017102 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0000X , with the licence number: 1013557 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1124471685 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".