Provider Demographics
NPI:1821569328
Name:HENRY, KAREN (CERT HAIR LOSS SPT)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:HENRY
Suffix:
Gender:F
Credentials:CERT HAIR LOSS SPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14865 262ND PL
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11422-3039
Mailing Address - Country:US
Mailing Address - Phone:718-598-4075
Mailing Address - Fax:
Practice Address - Street 1:13833 BROOKVILLE BLVD
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:NY
Practice Address - Zip Code:11422-1900
Practice Address - Country:US
Practice Address - Phone:718-481-3040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-09
Last Update Date:2018-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management