Individual
KEVIN HENDRICKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
11050 MT BELVEDERE BLVD, FORT DRUM, NY 13602-2603
(908) 255-2087
Mailing address
86 KNICKERBOCKER DR, BELLE MEAD, NJ 08502-4545
(908) 255-2087
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
0101282168
VA
207P00000X
Emergency Medicine Physician
339422
NY
2255A2300X
Athletic Trainer
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
08/24/2014
Last updated
01/26/2026
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