MEDICARE: WILLIAM J HENNESSEY MD PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207VG0400X	Gynecology Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DG4672	OTHER		RAILROAD MEDICARE

General Provider Information

NPI Number	:	1033225560
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLIAM J HENNESSEY MD PC

Provider Business Mailing Address
First Line	:	31 LOWER HUDSON AVE
Second Line	:
City	:	GREEN ISLAND
State	:	NY
Zip	:	12183-1014
Country	:	US
Telephone Number	:	518-272-9140
Fax Number	:

Provider Business Practice Location Address
First Line	:	31 LOWER HUDSON AVE
Second Line	:
City	:	GREEN ISLAND
State	:	NY
Zip	:	12183-1014
Country	:	US
Telephone Number	:	518-272-9140
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. WILLIAM J HENNESSEY
Credential	:	M.D.
Telephone Number	:	518-272-9140

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	03/04/2008

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