Provider Demographics
NPI:1932253309
Name:HENSLE, TERRY W (MD, LLC)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:W
Last Name:HENSLE
Suffix:
Gender:M
Credentials:MD, LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:699 TEANECK RD
Mailing Address - Street 2:STE. 103
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-4244
Mailing Address - Country:US
Mailing Address - Phone:201-645-3362
Mailing Address - Fax:
Practice Address - Street 1:699 TEANECK RD
Practice Address - Street 2:SUITE 103
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-4244
Practice Address - Country:US
Practice Address - Phone:201-645-3362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY132062174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNS1501OtherOXFORD
NY00434419Medicaid
NY32587OtherBLUE CROSS PPO
NY00434419Medicaid