Basic Information
| Provider Information | |||||||||
| NPI: | 1366614638 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SCOTT M HORWITZ 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: | SUITE #304A | ||||||||
| City: | BRIGHTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021353511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6172541344 | ||||||||
| FaxNumber: | 6177834803 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2008 | ||||||||
| LastUpdateDate: | 12/07/2009 | ||||||||
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| AuthorizedOfficialLastName: | HORWITZ | ||||||||
| AuthorizedOfficialFirstName: | SCOTT | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER SOLE PROPRIETOR | ||||||||
| AuthorizedOfficialTelephone: | 6172541344 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DPM | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
ID Information
| ID | Type | State | Issuer | Description | 0361666 | 05 | MA | MEDICAID | 5135420001 | 01 | MA | MEDICARE DME | OTHER |