Provider Demographics
NPI:1982408472
Name:HENRIQUEZ, FEDERICO ADOLFO (RN)
Entity type:Individual
Prefix:
First Name:FEDERICO
Middle Name:ADOLFO
Last Name:HENRIQUEZ
Suffix:
Gender:
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 DELANCEY ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10002-3275
Mailing Address - Country:US
Mailing Address - Phone:212-614-2840
Mailing Address - Fax:212-979-0925
Practice Address - Street 1:109 DELANCEY ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-3275
Practice Address - Country:US
Practice Address - Phone:212-614-2840
Practice Address - Fax:212-979-0925
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-03
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY581673163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)