Provider Demographics
NPI:1538744016
Name:HENESCH, GILA
Entity type:Individual
Prefix:
First Name:GILA
Middle Name:
Last Name:HENESCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GILA
Other - Middle Name:
Other - Last Name:HENESCH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:107 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:NY
Mailing Address - Zip Code:11559-1931
Mailing Address - Country:US
Mailing Address - Phone:516-761-0364
Mailing Address - Fax:516-295-5557
Practice Address - Street 1:923 BROADWAY
Practice Address - Street 2:
Practice Address - City:WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11598-1739
Practice Address - Country:US
Practice Address - Phone:516-239-1800
Practice Address - Fax:516-295-5557
Is Sole Proprietor?:No
Enumeration Date:2021-03-16
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007070-01363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical