Provider Demographics
NPI:1316312861
Name:HENDRICK, QUAWI
Entity type:Individual
Prefix:
First Name:QUAWI
Middle Name:
Last Name:HENDRICK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 WASHINGTON ST
Mailing Address - Street 2:SUITE #204
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07017-1401
Mailing Address - Country:US
Mailing Address - Phone:732-306-2909
Mailing Address - Fax:201-353-8009
Practice Address - Street 1:39 KEARNY ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07104-2611
Practice Address - Country:US
Practice Address - Phone:732-306-2909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-09
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0711069146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic