Provider Demographics
NPI:1902878598
Name:HENION, WILLIAM A (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:A
Last Name:HENION
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1445 PORTLAND AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621-3036
Mailing Address - Country:US
Mailing Address - Phone:585-544-1990
Mailing Address - Fax:585-544-1994
Practice Address - Street 1:1445 PORTLAND AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-3036
Practice Address - Country:US
Practice Address - Phone:585-544-1990
Practice Address - Fax:585-544-1994
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY110938207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00456886Medicaid
NY00456886Medicaid
NY10134BMedicare ID - Type Unspecified