MEDICARE: MS. ANGELA TANZIL HENNING PT

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	172V00000X	Community Health Worker	004799-1	NY
2	174H00000X	Health Educator	004799-1	NY
3	251E00000X	Home Health Agency	004799-1	NY

General Provider Information

NPI Number	:	1811222177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANGELA TANZIL HENNING PT

Provider Business Mailing Address
First Line	:	3 BERRY LN
Second Line	:
City	:	GLEN COVE
State	:	NY
Zip	:	11542-1713
Country	:	US
Telephone Number	:	519-759-0932
Fax Number	:

Provider Business Practice Location Address
First Line	:	75-20 ASTORIA BLVD
Second Line	:	SUITE 220
City	:	FLUSHING
State	:	NY
Zip	:	11369-9810
Country	:	US
Telephone Number	:	718-888-6923
Fax Number	:

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

Provider Enumeration Date	:	10/05/2009
Last Update Date	:	10/05/2009

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