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General NPI Number Information
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NPI Number | 1992980858
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Entity Type | Organization
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Legal Business Name | DR MARIANNE HENDRIX MD PC
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Dates
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Enumeration Date | 01/09/2008
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Last Update Date | 01/09/2008
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Provider Practice Location Address
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Address Line | 48 ROUTE 25A SUITE 203
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City | SMITHTOWN
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State | NY
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Zip | 11787-1431
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Country | US
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Telephone | 631-265-2126
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Fax |
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Provider Business Mailing Address
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Address Line | 48 ROUTE 25A SUITE 203
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City | SMITHTOWN
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State | NY
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Zip | 11787-1448
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Country | US
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Telephone | 631-265-2126
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Fax |
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Authorized Official
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Title or Position | MEDICAL RECORDS
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Name | MR. JOHN WILLARD
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Credential |
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Telephone | 631-265-2126
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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 |
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License Number State |
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