Healthcare Provider Details

I. General information

NPI: 1487814745
Provider Name (Legal Business Name): TONYA HENDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2008
Last Update Date: 04/11/2025
Certification Date: 04/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 E 53RD ST FL 4
NEW YORK NY
10022-4602
US

IV. Provider business mailing address

700 HICKSVILLE RD STE 205
BETHPAGE NY
11714-3472
US

V. Phone/Fax

Practice location:
  • Phone: 646-754-2700
  • Fax: 646-754-9803
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number329245
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: