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General NPI Number Information
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NPI Number | 1689074957
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Entity Type | Individual
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Provider Name | KEVIN HENDRICKSON
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Gender | Male
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Dates
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Enumeration Date | 08/24/2014
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Last Update Date | 01/26/2026
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Provider Practice Location Address
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Address Line | 11050 MT BELVEDERE BLVD
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City | FORT DRUM
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State | NY
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Zip | 13602-2603
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Country | US
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Telephone | 908-255-2087
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Fax |
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Provider Business Mailing Address
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Address Line | 86 KNICKERBOCKER DR
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City | BELLE MEAD
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State | NJ
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Zip | 08502-4545
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Country | US
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Telephone | 908-255-2087
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 0101282168
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 339422
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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