Provider Demographics
NPI:1376562017
Name:HENRY, GILLIAN L (MD)
Entity Type:Individual
Prefix:DR
First Name:GILLIAN
Middle Name:L
Last Name:HENRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:327 E 34TH ST
Mailing Address - Street 2:APT 3D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-4943
Mailing Address - Country:US
Mailing Address - Phone:212-263-0960
Mailing Address - Fax:212-263-5808
Practice Address - Street 1:160 E 32ND ST FL 2
Practice Address - Street 2:PEDIATRIC CARRDIOLOGY
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6004
Practice Address - Country:US
Practice Address - Phone:212-263-0960
Practice Address - Fax:212-263-5808
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY2712002080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
02606857OtherMMIS
NYI30329Medicare UPIN