Provider Demographics
NPI:1467779231
Name:HENN, FRITZ A (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:FRITZ
Middle Name:A
Last Name:HENN
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 PINE NECK AVE
Mailing Address - Street 2:
Mailing Address - City:EAST PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-5727
Mailing Address - Country:US
Mailing Address - Phone:631-627-3016
Mailing Address - Fax:631-344-5260
Practice Address - Street 1:BLDG. 490 BELL AVE
Practice Address - Street 2:BROOKHAVEN NATIONAL LABORATORY
Practice Address - City:UPTON
Practice Address - State:NY
Practice Address - Zip Code:11973-5000
Practice Address - Country:US
Practice Address - Phone:631-344-4049
Practice Address - Fax:631-344-5260
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-03
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY151086-12084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry