Basic Information
| Provider Information | |||||||||
| NPI: | 1285861120 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HENRY | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | EDWARD | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1634 PLYMOUTH AVE | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104614844 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8088590892 | ||||||||
| FaxNumber: | 8448043051 | ||||||||
| Practice Location | |||||||||
| Address1: | 1753 W RIDGEWAY AVE STE 107 | ||||||||
| Address2: | |||||||||
| City: | WATERLOO | ||||||||
| State: | IA | ||||||||
| PostalCode: | 507014588 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3198335907 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2009 | ||||||||
| LastUpdateDate: | 09/30/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | MD450954 | PA | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | MD0000056454 | TN | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 4301094689 | MI | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 5315041522 | MI | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | MD18168 | HI | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | MD-50117 | IA | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.