Provider Demographics
NPI:1578667960
Name:HOROWITZ, ROBERT WAYNE (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:WAYNE
Last Name:HOROWITZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:ROBERT
Other - Middle Name:WAYNE
Other - Last Name:FELDBLUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:101 DATES DR
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-1342
Mailing Address - Country:US
Mailing Address - Phone:607-272-5414
Mailing Address - Fax:607-272-6121
Practice Address - Street 1:101 DATES DR
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-1342
Practice Address - Country:US
Practice Address - Phone:607-272-5414
Practice Address - Fax:607-272-6121
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY185306207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME102100000Medicaid
G16588Medicare UPIN
MM7621Medicare ID - Type Unspecified
MEMM2289Medicare PIN