Provider Demographics
NPI:1336140375
Name:HENDRICKSON, PAUL S (DO)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:S
Last Name:HENDRICKSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1201 NOTT ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12308-2589
Mailing Address - Country:US
Mailing Address - Phone:518-374-3123
Mailing Address - Fax:518-374-9711
Practice Address - Street 1:1201 NOTT ST
Practice Address - Street 2:SUITE 106
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12308-2589
Practice Address - Country:US
Practice Address - Phone:518-374-3123
Practice Address - Fax:518-374-9711
Is Sole Proprietor?:No
Enumeration Date:2005-08-01
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY194397-1207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000405106001OtherBLUE SHIELD
000405106003OtherBLUE SHIELD NENY
12280OtherEMPIRE BLUE CROSS
33588ROtherFIDELIS MEDICARE
10000873OtherCDPHP
F77141OtherAMERICAN PROGRESSIVE TODA
000000083812OtherGHI HMO
NY01462151Medicaid
CAN1943976OtherWORKERS COMP
110160500OtherUS DEPT OF LABOR
PH01228010OtherEMPIRE BLUE CROSS
05311OtherMVP
040426006651OtherFIDELIS
194397-1OtherTRICARE NORTH REGION
9707078OtherGHI
CAN1943976OtherNO FAULT
PH01228020OtherEMPIRE BLUE CROSS
PH01228010OtherEMPIRE BLUE CROSS
33588ROtherFIDELIS MEDICARE
PH01228020OtherEMPIRE BLUE CROSS