Healthcare Provider Details

I. General information

NPI: 1407804859
Provider Name (Legal Business Name): GREGORY S HENDERSON MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 WAWAYANDA CT
WARWICK NY
10990-3346
US

IV. Provider business mailing address

30 WAWAYANDA CT
WARWICK NY
10990-3346
US

V. Phone/Fax

Practice location:
  • Phone: 206-790-2318
  • Fax:
Mailing address:
  • Phone: 206-790-2318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number273297
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: