1629406400 NPI number — MAX AARON HOROVITZ PH.D.

Table of content: MAX AARON HOROVITZ PH.D. (NPI 1629406400)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629406400 NPI number — MAX AARON HOROVITZ PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOROVITZ
Provider First Name:
MAX
Provider Middle Name:
AARON
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
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:
1629406400
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/09/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6867 SOUTHPOINT DR N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32216-8043
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-619-6071
Provider Business Mailing Address Fax Number:
904-212-0309

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10475 CENTURION PKWY N STE 301
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32256-5004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-308-3751
Provider Business Practice Location Address Fax Number:
904-308-6890
Provider Enumeration Date:
10/14/2013

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: 103TC0700X , with the licence number:  PY9132 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 014300300 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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