Provider Demographics
NPI:1063723823
Name:HENIGSON, THEODORE (MS,LAC)
Entity type:Individual
Prefix:MR
First Name:THEODORE
Middle Name:
Last Name:HENIGSON
Suffix:
Gender:M
Credentials:MS,LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:912 PRESIDENT ST FL 3
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-1604
Mailing Address - Country:US
Mailing Address - Phone:845-475-8375
Mailing Address - Fax:
Practice Address - Street 1:912 PRESIDENT ST FL 3
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-1604
Practice Address - Country:US
Practice Address - Phone:845-475-8375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-27
Last Update Date:2010-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004132-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist