Provider Demographics
NPI:1932173747
Name:HENSEL, GUSTAV LUKE (MSSM, ATC, SCC)
Entity Type:Individual
Prefix:MR
First Name:GUSTAV
Middle Name:LUKE
Last Name:HENSEL
Suffix:
Gender:M
Credentials:MSSM, ATC, SCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 ROUTE 447
Mailing Address - Street 2:
Mailing Address - City:NEWFOUNDLAND
Mailing Address - State:PA
Mailing Address - Zip Code:18445-5296
Mailing Address - Country:US
Mailing Address - Phone:570-766-5995
Mailing Address - Fax:
Practice Address - Street 1:501 ROUTE 447
Practice Address - Street 2:
Practice Address - City:NEWFOUNDLAND
Practice Address - State:PA
Practice Address - Zip Code:18445-5296
Practice Address - Country:US
Practice Address - Phone:570-766-5995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-16
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT001397002255A2300X
PART0053342255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MT00139700OtherNEW JERSEY OFFICE OF THE ATTORNEY GENERAL DIVISION OF CONSUMER AFFAIRS
080102002OtherNATIONAL ATHLETIC TRAINERS' ASSOCIATION CERTIFICATION NUMBER
PART005334OtherPENNSYLVANIA STATE BOARD OF MEDICAL EXAMINERS