Basic Information
| Provider Information | |||||||||
| NPI: | 1003802133 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HORWITZ | ||||||||
| FirstName: | SCOTT | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DPM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 280 WASHINGTON ST | ||||||||
| Address2: | SUITE 304A | ||||||||
| City: | BRIGHTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021353511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6172541344 | ||||||||
| FaxNumber: | 6177834803 | ||||||||
| Practice Location | |||||||||
| Address1: | 280 WASHINGTON ST | ||||||||
| Address2: | SUITE304A | ||||||||
| City: | BRIGHTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021353511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6172541344 | ||||||||
| FaxNumber: | 6177834803 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2005 | ||||||||
| LastUpdateDate: | 12/03/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213E00000X | 001787 | MA | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist |
ID Information
| ID | Type | State | Issuer | Description | 0361666 | 05 | MA | MEDICAID |