Healthcare Provider Details

I. General information

NPI: 1518311927
Provider Name (Legal Business Name): PATRICK HAENLEIN JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2016
Last Update Date: 03/11/2025
Certification Date: 03/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 10TH AVE
NEW YORK NY
10011-4718
US

IV. Provider business mailing address

1000 10TH AVE
NEW YORK NY
10019-1147
US

V. Phone/Fax

Practice location:
  • Phone: 212-523-6775
  • Fax:
Mailing address:
  • Phone: 212-523-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number301308
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number301308
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: