Provider Demographics
NPI:1013542174
Name:HENDAWI FAMILY PRACTICE
Entity Type:Organization
Organization Name:HENDAWI FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TARIQ
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDAWI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-699-2589
Mailing Address - Street 1:14902 PRESTON RD STE 404
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254-9105
Mailing Address - Country:US
Mailing Address - Phone:516-699-2589
Mailing Address - Fax:516-534-5059
Practice Address - Street 1:14902 PRESTON RD STE 404
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75254
Practice Address - Country:US
Practice Address - Phone:516-699-2589
Practice Address - Fax:516-534-5059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-10
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily HealthGroup - Single Specialty