Provider Demographics
NPI:1730821307
Name:HENRY, OLIVIA PATRICE (MD)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:PATRICE
Last Name:HENRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 CASTLE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-3202
Mailing Address - Country:US
Mailing Address - Phone:516-474-1111
Mailing Address - Fax:
Practice Address - Street 1:418 E 71ST ST STE 21
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4894
Practice Address - Country:US
Practice Address - Phone:516-474-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-12
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program