Provider Demographics
NPI:1326646993
Name:HENRY, STEPHEN ANTHONY
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:ANTHONY
Last Name:HENRY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:MARLBORO
Mailing Address - State:NY
Mailing Address - Zip Code:12542-6316
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:65 SOUTH ST
Practice Address - Street 2:
Practice Address - City:MARLBORO
Practice Address - State:NY
Practice Address - Zip Code:12542-6316
Practice Address - Country:US
Practice Address - Phone:845-275-4525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-15
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY332734164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse