Provider Demographics
NPI:1992980858
Name:DR MARIANNE HENDRIX MD PC
Entity type:Organization
Organization Name:DR MARIANNE HENDRIX MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL RECORDS
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-265-2126
Mailing Address - Street 1:48 ROUTE 25A
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-1448
Mailing Address - Country:US
Mailing Address - Phone:631-265-2126
Mailing Address - Fax:
Practice Address - Street 1:48 ROUTE 25A
Practice Address - Street 2:SUITE 203
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-1431
Practice Address - Country:US
Practice Address - Phone:631-265-2126
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-09
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty