Provider Demographics
NPI:1790108538
Name:TERRY W. HENSLE MD. LLC
Entity Type:Organization
Organization Name:TERRY W. HENSLE MD. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:W
Authorized Official - Last Name:HENSLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-645-3362
Mailing Address - Street 1:699 TEANECK RD
Mailing Address - Street 2:STE. 103
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-4244
Mailing Address - Country:US
Mailing Address - Phone:201-645-3362
Mailing Address - Fax:201-692-1363
Practice Address - Street 1:699 TEANECK ROAD
Practice Address - Street 2:STE. 103
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666
Practice Address - Country:US
Practice Address - Phone:201-645-3362
Practice Address - Fax:201-692-1363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-30
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03420300174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty