Provider Demographics
NPI:1891802468
Name:HENRIQUEZ, EDMEE M (MD)
Entity Type:Individual
Prefix:
First Name:EDMEE
Middle Name:M
Last Name:HENRIQUEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7315 NORTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-1144
Mailing Address - Country:US
Mailing Address - Phone:718-424-2788
Mailing Address - Fax:718-424-3513
Practice Address - Street 1:7315 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-1144
Practice Address - Country:US
Practice Address - Phone:718-424-2788
Practice Address - Fax:718-424-3513
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2022-12-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY218863207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02109415Medicaid
80187139OtherRR
80187139OtherRR
NY02109415Medicaid