MEDICARE: DR. CASSANDRA E HENDERSON M.D.

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	207VM0101X	Maternal & Fetal Medicine Physician	157094	NY

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	:	1831280411
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CASSANDRA E HENDERSON M.D.

Provider Business Mailing Address
First Line	:	225 E 57TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10022-2822
Country	:	US
Telephone Number	:	631-235-7727
Fax Number	:	631-206-9193

Provider Business Practice Location Address
First Line	:	225 E 57TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10022-2822
Country	:	US
Telephone Number	:	929-340-5745
Fax Number	:	212-715-0698

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

Provider Enumeration Date	:	09/27/2006
Last Update Date	:	12/02/2022

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