Healthcare Provider Details

I. General information

NPI: 1255593786
Provider Name (Legal Business Name): DR. CARLA SIOUX ROGERS-HENRY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2008
Last Update Date: 06/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 W 148TH ST APT 5G
NEW YORK NY
10031-3908
US

IV. Provider business mailing address

412 W 148TH ST APT 5G
NEW YORK NY
10031-3908
US

V. Phone/Fax

Practice location:
  • Phone: 917-407-1985
  • Fax:
Mailing address:
  • Phone: 917-407-1985
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number2460081
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: