Provider Demographics
NPI:1093406381
Name:HENRI, DICARBA N/A (MD)
Entity Type:Individual
Prefix:
First Name:DICARBA
Middle Name:N/A
Last Name:HENRI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 VERMELLA WAY # 2010
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-2601
Mailing Address - Country:US
Mailing Address - Phone:786-204-3384
Mailing Address - Fax:
Practice Address - Street 1:1423 BEDFORD AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11216-3840
Practice Address - Country:US
Practice Address - Phone:718-230-5885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-17
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY60-P121222-01207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine