Provider Demographics
NPI:1992845077
Name:HENRIQUES, EDGAR S (MD)
Entity Type:Individual
Prefix:
First Name:EDGAR
Middle Name:S
Last Name:HENRIQUES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 EVERETT RD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205
Mailing Address - Country:US
Mailing Address - Phone:518-482-1007
Mailing Address - Fax:518-489-6210
Practice Address - Street 1:130 EVERETT RD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205
Practice Address - Country:US
Practice Address - Phone:518-482-1007
Practice Address - Fax:518-489-6210
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY114044207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000405379001OtherBLUE SHIELD
56359OtherBCBS
81520016186OtherMVP
10000876OtherCDPHP
81520016186OtherMVP
000405379001OtherBLUE SHIELD