Provider Demographics
NPI:1831280411
Name:HENDERSON, CASSANDRA E (MD)
Entity Type:Individual
Prefix:DR
First Name:CASSANDRA
Middle Name:E
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:CASSANDRA
Other - Middle Name:HENDERSON
Other - Last Name:CARNEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MARRIED
Mailing Address - Street 1:225 E 57TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-2822
Mailing Address - Country:US
Mailing Address - Phone:631-235-7727
Mailing Address - Fax:631-206-9193
Practice Address - Street 1:225 E 57TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-2822
Practice Address - Country:US
Practice Address - Phone:929-340-5745
Practice Address - Fax:212-715-0698
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY157094207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY965559Medicaid
NYA63723Medicare UPIN
NY965559Medicaid