Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 183060 | NY |
NPI | 1366550691 |
---|---|
Provider Name | James Edward Henry |
First Address | Far Rockaway, NY 11691 |
Second Address | Far Rockaway, NY 11691 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2006 |
Last Update Date | 10/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01642126 | (05) | NY |
13292 | MEDICARE PAYOR ID (01) | NY |
G23604 | (02) |