Provider Demographics
NPI:1396706305
Name:WENGENDER, HENRY J (PA)
Entity type:Individual
Prefix:MR
First Name:HENRY
Middle Name:J
Last Name:WENGENDER
Suffix:
Gender:M
Credentials:PA
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:30 HAGEN DR
Mailing Address - Street 2:SUITE # 310
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14625-2658
Mailing Address - Country:US
Mailing Address - Phone:585-641-0400
Mailing Address - Fax:585-641-0300
Practice Address - Street 1:30 HAGEN DR
Practice Address - Street 2:SUITE # 310
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14625-2658
Practice Address - Country:US
Practice Address - Phone:585-641-0400
Practice Address - Fax:585-641-0300
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY004096363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY109267BJOtherPREFERRED CARE PRODUCTS
NYP22268Medicare UPIN
NY109267BJOtherPREFERRED CARE PRODUCTS