Provider Demographics
NPI:1316079304
Name:HENS, DENNIS C (RPT)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:C
Last Name:HENS
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 FATHER JOGUES PL
Mailing Address - Street 2:
Mailing Address - City:TICONDEROGA
Mailing Address - State:NY
Mailing Address - Zip Code:12883-1408
Mailing Address - Country:US
Mailing Address - Phone:518-585-2887
Mailing Address - Fax:518-585-7904
Practice Address - Street 1:6 FATHER JOGUES PL
Practice Address - Street 2:
Practice Address - City:TICONDEROGA
Practice Address - State:NY
Practice Address - Zip Code:12883-1408
Practice Address - Country:US
Practice Address - Phone:518-585-2887
Practice Address - Fax:518-585-7904
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002366-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY32525BMedicare PIN