Provider Demographics
NPI:1063470607
Name:HENNING, HAROLD JOHN JR (MD)
Entity Type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:JOHN
Last Name:HENNING
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11 APPLEWOOD LANETH 235
Mailing Address - Street 2:
Mailing Address - City:ETOBICOKE
Mailing Address - State:ON
Mailing Address - Zip Code:M9C 0C1
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4250 SHERWOODTOWNE BLVD
Practice Address - Street 2:
Practice Address - City:MISSISSAUGA
Practice Address - State:ON
Practice Address - Zip Code:M9C 0C1
Practice Address - Country:CA
Practice Address - Phone:905-896-7100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2019-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY228510207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02422159Medicaid
NYB69243Medicare UPIN
NYDD6261Medicare PIN