Healthcare Provider Details

I. General information

NPI: 1992845077
Provider Name (Legal Business Name): EDGAR S HENRIQUES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 EVERETT RD
ALBANY NY
12205
US

IV. Provider business mailing address

130 EVERETT RD
ALBANY NY
12205
US

V. Phone/Fax

Practice location:
  • Phone: 518-482-1007
  • Fax: 518-489-6210
Mailing address:
  • Phone: 518-482-1007
  • Fax: 518-489-6210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number114044
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: