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General NPI Number Information
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NPI Number | 1295836195
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Entity Type | Individual
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Provider Name | JEAN M HENNEBERRY MD
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Gender | Female
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Dates
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Enumeration Date | 09/26/2006
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Last Update Date | 01/29/2025
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Provider Practice Location Address
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Address Line | 560 WHITE PLAINS RD FL 6
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City | TARRYTOWN
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State | NY
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Zip | 10591-5155
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Country | US
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Telephone | 914-345-1100
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Fax | 914-345-1101
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Provider Business Mailing Address
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Address Line | 560 WHITE PLAINS RD FL 6
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City | TARRYTOWN
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State | NY
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Zip | 10591-5155
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Country | US
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Telephone | 914-345-1100
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZD0900X
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Taxonomy Name | Dermatopathology (Pathology) Physician
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License Number | 156584
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 207ZD0900X
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Taxonomy Name | Dermatopathology (Pathology) Physician
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License Number | 53620
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 207ZD0900X
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Taxonomy Name | Dermatopathology (Pathology) Physician
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License Number | 323463
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | 53620
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License Number State | CT
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