Provider Demographics
NPI:1982428785
Name:HENRY, PATRIQUE
Entity type:Individual
Prefix:
First Name:PATRIQUE
Middle Name:
Last Name:HENRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:174 S ORANGE AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:SOUTH ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07079-2270
Mailing Address - Country:US
Mailing Address - Phone:973-626-5663
Mailing Address - Fax:855-678-8887
Practice Address - Street 1:174 S ORANGE AVE APT 4
Practice Address - Street 2:
Practice Address - City:SOUTH ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07079-2270
Practice Address - Country:US
Practice Address - Phone:973-626-5663
Practice Address - Fax:855-678-8887
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-09
Last Update Date:2024-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008069224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant