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General NPI Number Information
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NPI Number | 1467779231
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Entity Type | Individual
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Provider Name | FRITZ A. HENN MD, PH.D
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Gender | Male
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Dates
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Enumeration Date | 05/03/2010
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Last Update Date | 05/03/2010
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Provider Practice Location Address
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Address Line | BLDG. 490 BELL AVE BROOKHAVEN NATIONAL LABORATORY
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City | UPTON
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State | NY
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Zip | 11973-5000
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Country | US
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Telephone | 631-344-4049
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Fax | 631-344-5260
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Provider Business Mailing Address
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Address Line | 131 PINE NECK AVE
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City | EAST PATCHOGUE
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State | NY
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Zip | 11772-5727
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Country | US
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Telephone | 631-627-3016
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Fax | 631-344-5260
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 151086-1
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License Number State | NY
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