Provider Demographics
NPI:1285694661
Name:HENNESSEY, N PATRICK (MD)
Entity type:Individual
Prefix:DR
First Name:N
Middle Name:PATRICK
Last Name:HENNESSEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 MADISON AVE RM 6SE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-5454
Mailing Address - Country:US
Mailing Address - Phone:212-677-5555
Mailing Address - Fax:212-677-5558
Practice Address - Street 1:161 MADISON AVE RM 6SE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-5454
Practice Address - Country:US
Practice Address - Phone:212-677-5555
Practice Address - Fax:212-677-5558
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY133471174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB12682Medicare UPIN