Provider Demographics
NPI:1750492542
Name:HENRY, WILLIAM MERTON JR (NP)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:MERTON
Last Name:HENRY
Suffix:JR
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 NEWTON ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14504-9770
Mailing Address - Country:US
Mailing Address - Phone:585-289-7036
Mailing Address - Fax:
Practice Address - Street 1:435 E HENRIETTA RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-4629
Practice Address - Country:US
Practice Address - Phone:585-760-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF340601363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health