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Individual
DOUGLAS R HENNEBERG
Active
Individual
DOUGLAS R HENNEBERG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Taxonomy
Speciality
Code
Description
License number
State
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
Primary
001092
NY
Other
Enumeration date
05/17/2021
Last updated
05/17/2021
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