Provider Demographics
NPI:1366550691
Name:HENRY, JAMES EDWARD (DO PC AOAOS)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:EDWARD
Last Name:HENRY
Suffix:
Gender:M
Credentials:DO PC AOAOS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:347 BEACH 19TH STREET
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691
Mailing Address - Country:US
Mailing Address - Phone:718-869-8888
Mailing Address - Fax:718-869-8893
Practice Address - Street 1:347 BEACH 19TH STREET
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691
Practice Address - Country:US
Practice Address - Phone:718-869-8888
Practice Address - Fax:718-869-8893
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY183060207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY13292OtherMEDICARE PAYOR ID
NY01642126Medicaid
NY01642126Medicaid
NY04829Medicare ID - Type Unspecified
NY6514UFMedicare PIN