1124252580 NPI number — DR. G.M. HENNING, D.C., P.C.

Table of content: (NPI 1124252580)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124252580 NPI number — DR. G.M. HENNING, D.C., P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR. G.M. HENNING, D.C., P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DR GUNNAR M HENNING DC PC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124252580
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/13/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 E WASHINGTON AVE
Provider Second Line Business Mailing Address:
1ST FLOOR
Provider Business Mailing Address City Name:
WASHINGTON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07882-1400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
908-835-1515
Provider Business Mailing Address Fax Number:
908-835-1114

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 E WASHINGTON AVE
Provider Second Line Business Practice Location Address:
1ST FLOOR
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07882-1400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-835-1515
Provider Business Practice Location Address Fax Number:
908-835-1114
Provider Enumeration Date:
05/13/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HENNING
Authorized Official First Name:
GUNNAR
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
908-835-1515

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  38MC00222600 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)