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General NPI Number Information
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NPI Number | 1609858463
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Entity Type | Individual
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Provider Name | CARL T HENNINGSON JR. M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/17/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1707 ATLANTIC AVE
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City | MANASQUAN
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State | NJ
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Zip | 08736-1147
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Country | US
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Telephone | 732-528-0760
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Fax | 732-528-0764
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Provider Business Mailing Address
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Address Line | 1707 ATLANTIC AVE
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City | MANASQUAN
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State | NJ
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Zip | 08736-1147
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Country | US
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Telephone | 732-528-0760
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Fax | 732-528-0764
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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 | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 25MA07630600
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License Number State | NJ
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