Individual
DR. HORACE A HAWTHORNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
101 S BERGEN PL, LONG ISLAND FQHC, INC., FREEPORT, NY 11520-3528
(516) 623-3600
(516) 623-9191
Mailing address
380 NASSAU RD, LONG ISLAND FQHC, INC., ROOSEVELT, NY 11575-1343
(516) 571-8600
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
228249
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02483549
—
NY
Enumeration date
11/30/2005
Last updated
01/24/2014
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