Healthcare Provider Details

I. General information

NPI: 1912496522
Provider Name (Legal Business Name): JULIE HENDERSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2018
Last Update Date: 07/03/2023
Certification Date: 07/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 HUGUENOT ST
NEW ROCHELLE NY
10801-7760
US

IV. Provider business mailing address

800 WESTCHESTER AVE STE N715
RYE BROOK NY
10573-1369
US

V. Phone/Fax

Practice location:
  • Phone: 914-607-4720
  • Fax:
Mailing address:
  • Phone: 908-588-3635
  • Fax: 908-934-9350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number67567
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number323017
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: