MEDICARE: EDGAR R. HENRIQUES M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208M00000X	Hospitalist Physician	231783	NY
2	207R00000X	Internal Medicine Physician	231783	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508868415
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDGAR R. HENRIQUES M.D.

Provider Business Mailing Address
First Line	:	4 ATRIUM DR
Second Line	:	SUITE 100, ATTN: TAMMY M. BUTTON
City	:	ALBANY
State	:	NY
Zip	:	12205-1441
Country	:	US
Telephone Number	:	518-435-2740
Fax Number	:	518-458-2610

Provider Business Practice Location Address
First Line	:	315 S MANNING BLVD
Second Line	:	6 CUSACK
City	:	ALBANY
State	:	NY
Zip	:	12208-1707
Country	:	US
Telephone Number	:	518-525-8600
Fax Number	:	518-525-6891

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	04/29/2020

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