Provider Demographics
NPI:1568420362
Name:HENOCH, MONICA J (MD)
Entity Type:Individual
Prefix:DR
First Name:MONICA
Middle Name:J
Last Name:HENOCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 FINTRAY PL
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14607-2912
Mailing Address - Country:US
Mailing Address - Phone:585-461-1029
Mailing Address - Fax:
Practice Address - Street 1:2 FINTRAY PL
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14607-2912
Practice Address - Country:US
Practice Address - Phone:585-461-1029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY169999208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY050915000103OtherFIDELIS
NY00355266Medicaid
NY00025371101OtherUNIVERA
NY102532DLOtherPREFERRED CARE
NYP010169999OtherBLUE CHOICE
NY1292608OtherIHA
NY11122747OtherCAQH
NY11122747OtherCAQH
NYP010169999OtherBLUE CHOICE