Provider Demographics
NPI:1528103926
Name:JULIAN L HENLEY MD PC
Entity type:Organization
Organization Name:JULIAN L HENLEY MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:HENLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-787-4647
Mailing Address - Street 1:1423 CHAPEL STREET
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511
Mailing Address - Country:US
Mailing Address - Phone:203-787-4647
Mailing Address - Fax:203-785-1861
Practice Address - Street 1:1423 CHAPEL STREET
Practice Address - Street 2:SUITE 1A
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511
Practice Address - Country:US
Practice Address - Phone:203-787-4647
Practice Address - Fax:203-785-1861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT20671174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
B83442Medicare UPIN