MEDICARE: GILA HENESCH

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	363AM0700X	Medical Physician Assistant	007070-01	NY

General Provider Information

NPI Number	:	1538744016
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GILA HENESCH

Provider Business Mailing Address
First Line	:	107 HARRISON ST
Second Line	:
City	:	LAWRENCE
State	:	NY
Zip	:	11559-1931
Country	:	US
Telephone Number	:	516-761-0364
Fax Number	:	516-295-5557

Provider Business Practice Location Address
First Line	:	923 BROADWAY
Second Line	:
City	:	WOODMERE
State	:	NY
Zip	:	11598-1739
Country	:	US
Telephone Number	:	516-239-1800
Fax Number	:	516-295-5557

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

Provider Enumeration Date	:	03/16/2021
Last Update Date	:	03/16/2021

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Directions to “ GILA HENESCH ” Practice Location

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