Provider Demographics
NPI:1043421373
Name:HENRY, WENDY (LAC)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:HENRY
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 JANE ST APT 5L
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10014-1758
Mailing Address - Country:US
Mailing Address - Phone:212-243-5736
Mailing Address - Fax:
Practice Address - Street 1:100 JANE ST APT 5L
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10014-1758
Practice Address - Country:US
Practice Address - Phone:212-243-5736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2511171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist