Provider Demographics
NPI:1740397348
Name:HENRIQUEZ, JOSE (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:HENRIQUEZ
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 1:103 NEWTOWN RD
Mailing Address - Street 2:CANDLEWOOD CENTER FOR WOMEN'S HEALTH
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-4143
Mailing Address - Country:US
Mailing Address - Phone:203-730-8789
Mailing Address - Fax:203-743-5229
Practice Address - Street 1:103 NEWTOWN RD
Practice Address - Street 2:CANDLEWOOD CENTER FOR WOMEN'S HEALTH
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-4143
Practice Address - Country:US
Practice Address - Phone:203-730-8789
Practice Address - Fax:203-743-5229
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT027488207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B84307Medicare UPIN