Healthcare Provider Details

I. General information

NPI: 1982408472
Provider Name (Legal Business Name): FEDERICO ADOLFO HENRIQUEZ RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2025
Last Update Date: 04/03/2025
Certification Date: 04/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 DELANCEY ST
NEW YORK NY
10002-3275
US

IV. Provider business mailing address

109 DELANCEY ST
NEW YORK NY
10002-3275
US

V. Phone/Fax

Practice location:
  • Phone: 212-614-2840
  • Fax: 212-979-0925
Mailing address:
  • Phone: 212-614-2840
  • Fax: 212-979-0925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number581673
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: