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General NPI Number Information
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NPI Number | 1851335863
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Entity Type | Individual
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Provider Name | STEPHEN MARK HENESCH D. O.
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Gender | Male
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Dates
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Enumeration Date | 06/16/2006
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Last Update Date | 07/29/2011
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Provider Practice Location Address
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Address Line | 1000 MONTAUK HWY
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City | WEST ISLIP
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State | NY
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Zip | 11795-4927
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Country | US
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Telephone | 631-376-4027
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Fax | 631-376-4046
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Provider Business Mailing Address
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Address Line | PO BOX 5918
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City | NEW YORK
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State | NY
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Zip | 10087-5918
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Country | US
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Telephone | 800-827-8415
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Fax | 315-295-2117
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 238991
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License Number State | NY
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