Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 52523 | GA |
N | 207X00000X | Orthopaedic Surgeon | A92330 | CA |
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 25MA09165800 | NJ |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 25MA09165800 | NJ |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 271409-1 | NY |
NPI | 1326005307 |
---|---|
Provider Name | Timothy J Henderson |
First Address | Boston, MA 02241-6457 |
Second Address | Wayne, NJ 07470 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2006 |
Last Update Date | 29/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I40137 | (02) |