Basic Information
| Provider Information | |||||||||
| NPI: | 1225093958 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HENIG | ||||||||
| FirstName: | DONNA | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 226 MILL HILL AVE | ||||||||
| Address2: | 3RD FLOOR | ||||||||
| City: | BRIDGEPORT | ||||||||
| State: | CT | ||||||||
| PostalCode: | 066102826 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2038633840 | ||||||||
| FaxNumber: | 2038633467 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 CARMAN AVE | ||||||||
| Address2: | |||||||||
| City: | EAST MEADOW | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115541160 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5165723946 | ||||||||
| FaxNumber: | 5165724367 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2006 | ||||||||
| LastUpdateDate: | 04/30/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 1751991 | NY | N | Other Service Providers | Specialist | 207R00000X | 175199 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 061574360 | 01 | NY | AETNA | OTHER | P644318 | 01 | NY | OXFORD | OTHER | BK2457972 | 01 | NY | DEA | OTHER | 010030253CT02 | 01 | NY | BLUE SHIELD | OTHER | 0240772 | 01 | NY | CIGNA | OTHER |