Provider Demographics
NPI:1427347525
Name:HENNER, MARC
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:
Last Name:HENNER
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 1:846 CLIFFSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11581-3046
Mailing Address - Country:US
Mailing Address - Phone:516-987-4244
Mailing Address - Fax:
Practice Address - Street 1:846 CLIFFSIDE AVE
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11581-3046
Practice Address - Country:US
Practice Address - Phone:516-987-4244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-30
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program