Provider Demographics
NPI:1184162356
Name:HENNESSY MEDICAL PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:HENNESSY MEDICAL PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:HENNESSY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:973-895-3288
Mailing Address - Street 1:3155 STATE ROUTE 10 STE 215
Mailing Address - Street 2:
Mailing Address - City:DENVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07834-3430
Mailing Address - Country:US
Mailing Address - Phone:973-895-3288
Mailing Address - Fax:973-895-9047
Practice Address - Street 1:3155 RT 10 EAST
Practice Address - Street 2:SUITE 215
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834-3430
Practice Address - Country:US
Practice Address - Phone:973-895-3288
Practice Address - Fax:973-895-9047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-07
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00319000213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty