=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518148634
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DONNA L.HENIG, M.D.,P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/16/2007
-----------------------------------------------------
Last Update Date | 11/16/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4200 SUNRISE HWY SUITE 2
-----------------------------------------------------
City | MASSAPEQUA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11758-5303
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-598-4999
-----------------------------------------------------
Fax | 516-598-4998
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4200 SUNRISE HWY SUITE 2
-----------------------------------------------------
City | MASSAPEQUA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11758-5303
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-598-4999
-----------------------------------------------------
Fax | 516-598-4998
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | INTERNIST
-----------------------------------------------------
Name | DR. DONNA LYNN HENIG
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 516-598-4999
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 175199-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------