MEDICARE: MR. ANTHONY HENRIQUEZ

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	172A00000X	Driver	739824310	NY

General Provider Information

NPI Number	:	1144922212
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ANTHONY HENRIQUEZ

Provider Business Mailing Address
First Line	:	20 SPRING ST
Second Line	:
City	:	HAVERSTRAW
State	:	NY
Zip	:	10927-1028
Country	:	US
Telephone Number	:	845-650-1515
Fax Number	:

Provider Business Practice Location Address
First Line	:	20 SPRING ST
Second Line	:
City	:	HAVERSTRAW
State	:	NY
Zip	:	10927-1028
Country	:	US
Telephone Number	:	845-650-1515
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/21/2023
Last Update Date	:	03/21/2023

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