1104802925 NPI number — HENRY N MENSACK P.A.-C

Table of content: HENRY N MENSACK P.A.-C (NPI 1104802925)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104802925 NPI number — HENRY N MENSACK P.A.-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MENSACK
Provider First Name:
HENRY
Provider Middle Name:
N
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.A.-C
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1104802925
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/13/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 607
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GEORGETOWN
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19947-0607
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-424-4141
Provider Business Mailing Address Fax Number:
302-422-6506

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
329 MULLET RUN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILFORD
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19963-5373
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-749-4154
Provider Business Practice Location Address Fax Number:
410-860-9583
Provider Enumeration Date:
12/22/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  C5-0000229 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1184681488 . This is a "COMMERCIAL INSURANCES" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1104802925 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".




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