Provider Demographics
NPI:1841368958
Name:HENRY, JAMES R (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:HENRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1301 ROUTE 72 W
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MANAHAWKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08050-2417
Mailing Address - Country:US
Mailing Address - Phone:609-597-6513
Mailing Address - Fax:609-597-4593
Practice Address - Street 1:1301 ROUTE 72 W
Practice Address - Street 2:SUITE 300
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-2417
Practice Address - Country:US
Practice Address - Phone:609-597-6513
Practice Address - Fax:609-597-4593
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA03822300207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ223012814OtherDEVON
NJ223012814OtherHORIZON
NJ1K3459OtherHEALTH NET
NJ223012814OtherATLANTICARE
NJ010063220OtherRAIL ROAD MEDICARE
NJ0272239000OtherAMERIHEALTH
NJ223012814OtherQUALCARE
NJD19246Medicare UPIN
NJ1K3459OtherHEALTH NET