Healthcare Provider Details

I. General information

NPI: 1396033924
Provider Name (Legal Business Name): TERRY W. HENSLE, M.D., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2011
Last Update Date: 07/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

699 TEANECK RD
TEANECK NJ
07666-4244
US

IV. Provider business mailing address

699 TEANECK RD
TEANECK NJ
07666-4244
US

V. Phone/Fax

Practice location:
  • Phone: 201-695-3362
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License Number25MA03420300
License Number StateNJ

VIII. Authorized Official

Name: TERRY W HENSLE
Title or Position: OWNER
Credential: M.D.
Phone: 201-695-3362