Provider Demographics
NPI:1942372610
Name:HENNESSY, EDWARD (DC, CDN)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:
Last Name:HENNESSY
Suffix:
Gender:M
Credentials:DC, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 TRINITY PL
Mailing Address - Street 2:
Mailing Address - City:NANUET
Mailing Address - State:NY
Mailing Address - Zip Code:10954-1043
Mailing Address - Country:US
Mailing Address - Phone:845-624-2542
Mailing Address - Fax:
Practice Address - Street 1:5 GRANDVIEW AVE
Practice Address - Street 2:
Practice Address - City:NANUET
Practice Address - State:NY
Practice Address - Zip Code:10954-2510
Practice Address - Country:US
Practice Address - Phone:845-623-3939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX005350111N00000X
NY002812-1133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered133N00000XDietary & Nutritional Service ProvidersNutritionist