Provider Demographics
NPI:1104827591
Name:HENKEN, HERBERT C (MD)
Entity Type:Individual
Prefix:
First Name:HERBERT
Middle Name:C
Last Name:HENKEN
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 1:511 E PARK AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-3741
Mailing Address - Country:US
Mailing Address - Phone:516-889-1518
Mailing Address - Fax:516-889-1519
Practice Address - Street 1:511 E PARK AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-3741
Practice Address - Country:US
Practice Address - Phone:516-889-1518
Practice Address - Fax:516-889-1519
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY147107207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00812919Medicaid
059A611Medicare ID - Type Unspecified
D34104Medicare UPIN