Provider Demographics
NPI:1346630795
Name:HENDERSON, MARIE (DO)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:
Other - Last Name:HENDERSON-BAKAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:101 SO. BEDFORD RD
Mailing Address - Street 2:STE 413
Mailing Address - City:MT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549
Mailing Address - Country:US
Mailing Address - Phone:914-666-6792
Mailing Address - Fax:
Practice Address - Street 1:101 S BEDFORD RD
Practice Address - Street 2:SUITE 413
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549
Practice Address - Country:US
Practice Address - Phone:914-666-6792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-23
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY201987207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine