Healthcare Provider Details

I. General information

NPI: 1679556807
Provider Name (Legal Business Name): JANET B HENRICH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 12/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

789 HOWARD AVE YALE PHYSICIANS BUILDING
NEW HAVEN CT
06519-1304
US

IV. Provider business mailing address

PO BOX 9805 300 GEORGE ST, 6TH FLOOR
NEW HAVEN CT
06536-0805
US

V. Phone/Fax

Practice location:
  • Phone: 203-688-2471
  • Fax: 203-688-4516
Mailing address:
  • Phone: 203-785-7998
  • Fax: 203-785-6414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number020662
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: