Provider Demographics
NPI:1053580647
Name:HORRI, MARYAM
Entity type:Individual
Prefix:
First Name:MARYAM
Middle Name:
Last Name:HORRI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 ROCKEFELLER PLZ
Mailing Address - Street 2:SUITE 1807
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10111-0100
Mailing Address - Country:US
Mailing Address - Phone:212-586-0410
Mailing Address - Fax:
Practice Address - Street 1:45 ROCKEFELLER PLZ
Practice Address - Street 2:SUITE 1807
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10111-0100
Practice Address - Country:US
Practice Address - Phone:212-586-0410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-27
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045073122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist