Provider Demographics
NPI:1548483076
Name:HENSON, JENNIFER T (MD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:T
Last Name:HENSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:711 TROY SCHENECTADY RD STE 203
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2461
Mailing Address - Country:US
Mailing Address - Phone:518-782-3700
Mailing Address - Fax:518-782-3799
Practice Address - Street 1:1667 ELIZABETH ST
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12303-3805
Practice Address - Country:US
Practice Address - Phone:518-356-5377
Practice Address - Fax:518-881-1489
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2018-01-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35.090299207Q00000X
NY272519207Q00000X
CAA72197207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7512D2OtherEMPIRE BCBS
CA00A721970OtherMEDI-CAL
NY140203000144OtherFIDELIS
NY7071255OtherAETNA
NY03753500Medicaid
NY712385OtherGHI/HMO
NY140203000144OtherFIDELIS
NY7512D2OtherEMPIRE BCBS