Provider Demographics
NPI:1588209035
Name:HENRY, MACARY (APN-BC)
Entity Type:Individual
Prefix:
First Name:MACARY
Middle Name:
Last Name:HENRY
Suffix:
Gender:M
Credentials:APN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1830 STALLION CT
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08094-8745
Mailing Address - Country:US
Mailing Address - Phone:856-881-2410
Mailing Address - Fax:
Practice Address - Street 1:249 S DELSEA DR
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NJ
Practice Address - Zip Code:08312-2203
Practice Address - Country:US
Practice Address - Phone:856-203-1657
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-07
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00975000363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health