Healthcare Provider Details

I. General information

NPI: 1952325649
Provider Name (Legal Business Name): WILLIAM J HENNESSEY MD PC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 03/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 LOWER HUDSON AVE
GREEN ISLAND NY
12183-1014
US

IV. Provider business mailing address

ONE FOREST MEADOWS
RENSSELAER NY
12144
US

V. Phone/Fax

Practice location:
  • Phone: 518-272-9140
  • Fax:
Mailing address:
  • Phone: 518-283-9611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number120355
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: