MEDICARE: BERNARD HENSON

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	208600000X	Surgery Physician	MA03972500	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710060314
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BERNARD HENSON

Provider Business Mailing Address
First Line	:	220 HAMBURG TPKE STE 18A
Second Line	:
City	:	WAYNE
State	:	NJ
Zip	:	07470-2132
Country	:	US
Telephone Number	:	973-904-1704
Fax Number	:	973-595-8741

Provider Business Practice Location Address
First Line	:	220 HAMBURG TPKE STE 18A
Second Line	:
City	:	WAYNE
State	:	NJ
Zip	:	07470-2132
Country	:	US
Telephone Number	:	973-904-1704
Fax Number	:	973-595-8741

Authorized Official
Title or Position	:	OWNER
Name	:	BERNARD HENSON
Credential	:	MD
Telephone Number	:	973-904-1704

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	07/24/2008

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Directions to “BERNARD HENSON ” Practice Location

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