Provider Demographics
NPI:1205873940
Name:HOROWITZ, SANDRA L (MD)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:L
Last Name:HOROWITZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SANDRA
Other - Middle Name:
Other - Last Name:HOROWITZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1153 CENTRE ST
Mailing Address - Street 2:SUITE 47
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-3446
Mailing Address - Country:US
Mailing Address - Phone:617-983-7580
Mailing Address - Fax:617-983-4868
Practice Address - Street 1:1153 CENTRE ST
Practice Address - Street 2:SUITE 47
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-3446
Practice Address - Country:US
Practice Address - Phone:617-983-7580
Practice Address - Fax:617-983-4868
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA497132084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology