Provider Demographics
NPI:1184668949
Name:HENNIGES, MARIAN (AUD)
Entity Type:Individual
Prefix:
First Name:MARIAN
Middle Name:
Last Name:HENNIGES
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:MARIAN
Other - Middle Name:
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:4 DEARFIELD LN 104
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06831-5326
Mailing Address - Country:US
Mailing Address - Phone:203-629-5500
Mailing Address - Fax:203-629-8244
Practice Address - Street 1:4 DEARFIELD DR
Practice Address - Street 2:SUITE 104
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06831-5351
Practice Address - Country:US
Practice Address - Phone:203-629-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000922231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04786LMedicare PIN
NYM22501Medicare PIN