Basic Information
Provider Information | |||||||||
NPI: | 1922093376 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | HORNG | ||||||||
FirstName: | JACK | ||||||||
MiddleName: | W | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 20 GRAND ST | ||||||||
Address2: | 3RD FLOOR | ||||||||
City: | WARWICK | ||||||||
State: | NY | ||||||||
PostalCode: | 109901035 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8459873906 | ||||||||
FaxNumber: | 8459875979 | ||||||||
Practice Location | |||||||||
Address1: | 2 CROSFIELD AVE | ||||||||
Address2: | SUITE 318 | ||||||||
City: | WEST NYACK | ||||||||
State: | NY | ||||||||
PostalCode: | 109942226 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8453535600 | ||||||||
FaxNumber: | 8453535668 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/13/2005 | ||||||||
LastUpdateDate: | 05/17/2016 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0200X | 2063691 | NY | N |   | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207RP1001X | 2063691 | NY | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | 207RS0012X | 206369 | NY | N |   | Allopathic & Osteopathic Physicians | Internal Medicine | Sleep Medicine | 207R00000X | 206369 | NY | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 02155053 | 05 | NY |   | MEDICAID | 132995699 | 01 |   | HEATLH NOW | OTHER | 0D2071 | 01 |   | HEALTHNET OF THE NORTHEAS | OTHER | 132995699 | 01 |   | FAM HEALTH PLUS | OTHER | 132995699 | 01 |   | HUDSON HEALTH PLAN MCD | OTHER | 2596421 | 01 |   | GHI ALL PLANS EXCEPT HMO | OTHER | 33353P | 01 |   | HIP | OTHER | 7588161 | 01 |   | AETNA | OTHER | 132995599 | 01 |   | CIGNA PPO | OTHER | 132995699 | 01 |   | BEECH STREET NETWORK | OTHER | 132995699 | 01 |   | FEDELIS MEDICAID HMO | OTHER | 132995699 | 01 |   | HORIZON HEALTHCARE OF NY | OTHER | 1C4591 | 01 |   | BCBS EMPIRE | OTHER | 132995699 | 01 |   | MAGNACARE PPO | OTHER | 2522147 | 01 |   | AETNA USHC | OTHER | 132995699 | 01 |   | INDECS ORANGE ULSTER SCHL | OTHER | 132995699 | 01 |   | LOCAL 1199 | OTHER | 0053968 | 01 |   | GHI HMO | OTHER |