Individual
STEPHEN MARK HENESCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D. O.
Contact information
Practice address
1000 MONTAUK HWY, WEST ISLIP, NY 11795-4927
(631) 376-4027
(631) 376-4046
Mailing address
PO BOX 5918, NEW YORK, NY 10087-5918
(800) 827-8415
(315) 295-2117
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
238991
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02801009
—
NY
Enumeration date
06/16/2006
Last updated
07/29/2011
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