1770790131 NPI number — DR. ELLEN GAIL HOROVITZ ATR-BC, LCAT

Table of content: DR. ELLEN GAIL HOROVITZ ATR-BC, LCAT (NPI 1770790131)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770790131 NPI number — DR. ELLEN GAIL HOROVITZ ATR-BC, LCAT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOROVITZ
Provider First Name:
ELLEN
Provider Middle Name:
GAIL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
ATR-BC, LCAT
Provider Gender Code:
F

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:
1770790131
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/02/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 CANALSIDE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPENCERPORT
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14559-1347
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-704-1890
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 CANALSIDE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPENCERPORT
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14559-1347
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-704-1890
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/16/2007

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: 101YM0800X , with the licence number:  05 000467 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 221700000X , with the licence number: 05 000467 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 101YM0800X . This is a "COUNSELOR, MENTAL HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 05 000467 . This is a "ART THERAPY LICENSE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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