Provider Demographics
NPI:1427002278
Name:HOM, HENRY (MD)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:
Last Name:HOM
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 1:54 W 21ST ST RM 910
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-7329
Mailing Address - Country:US
Mailing Address - Phone:212-592-9117
Mailing Address - Fax:212-337-8528
Practice Address - Street 1:54 W 21ST ST RM 910
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-7329
Practice Address - Country:US
Practice Address - Phone:212-592-9117
Practice Address - Fax:212-337-8528
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY197592207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG13301Medicare UPIN