Provider Demographics
NPI:1003966409
Name:HENIK, WILLY (PHD)
Entity Type:Individual
Prefix:DR
First Name:WILLY
Middle Name:
Last Name:HENIK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7000 KENNEDY BLVD E
Mailing Address - Street 2:1-50 B
Mailing Address - City:GUTTENBERG
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-4818
Mailing Address - Country:US
Mailing Address - Phone:201-453-8744
Mailing Address - Fax:
Practice Address - Street 1:7000 KENNEDY BLVD E
Practice Address - Street 2:1-50 B
Practice Address - City:GUTTENBERG
Practice Address - State:NJ
Practice Address - Zip Code:07093-4818
Practice Address - Country:US
Practice Address - Phone:201-453-8744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1035103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical