Basic Information
| Provider Information | |||||||||
| NPI: | 1053371765 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JANSSEN | ||||||||
| FirstName: | HENRY | ||||||||
| MiddleName: | HERMAN | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 110 S BEDFORD RD | ||||||||
| Address2: | |||||||||
| City: | MOUNT KISCO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105493446 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9142411050 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 90 S BEDFORD RD | ||||||||
| Address2: | |||||||||
| City: | MOUNT KISCO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105493412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9142411050 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/25/2006 | ||||||||
| LastUpdateDate: | 12/13/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 037751 | CT | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 300128165 | 01 | CT | RAILROAD MEDICARE | OTHER | 010037751CT14 | 01 | CT | ANTHEM BC/BS | OTHER | 300128159 | 01 | CT | RAILROAD MEDICARE | OTHER | 001377515 | 05 | CT | MEDICAID | 300128163 | 01 | CT | RAILROAD MEDICARE | OTHER | 010037751CT06 | 01 | CT | ANTHEM BC/BS | OTHER | 010037751CT07 | 01 | CT | ANTHEM BC/BS | OTHER | 010037751CT12 | 01 | CT | ANTHEM BC/BS | OTHER | P00124616 | 01 | CT | RAILROAD MEDICARE | OTHER | 010037751CT10 | 01 | CT | ANTHEM BC/BS | OTHER |