Provider Demographics
NPI:1972586212
Name:PARTRIDGE, HENRY S (MD)
Entity type:Individual
Prefix:
First Name:HENRY
Middle Name:S
Last Name:PARTRIDGE
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 1:77 N CENTRE AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-3923
Mailing Address - Country:US
Mailing Address - Phone:516-678-0909
Mailing Address - Fax:516-678-0631
Practice Address - Street 1:77 N CENTRE AVE
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-3923
Practice Address - Country:US
Practice Address - Phone:516-678-0909
Practice Address - Fax:516-678-0631
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-21
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY105496208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00184345Medicaid
NY00184345Medicaid
B17910Medicare UPIN