Provider Demographics
NPI:1851072904
Name:HENRY, ZACHARIAH (CRNA)
Entity Type:Individual
Prefix:MR
First Name:ZACHARIAH
Middle Name:
Last Name:HENRY
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:623 FOXGLOVE DR
Mailing Address - Street 2:
Mailing Address - City:MORTON
Mailing Address - State:PA
Mailing Address - Zip Code:19070-1643
Mailing Address - Country:US
Mailing Address - Phone:812-322-5103
Mailing Address - Fax:
Practice Address - Street 1:700 ROUTE 130 N STE 203
Practice Address - Street 2:
Practice Address - City:CINNAMINSON
Practice Address - State:NJ
Practice Address - Zip Code:08077-3366
Practice Address - Country:US
Practice Address - Phone:856-829-3457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-31
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR21620600367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered