Provider Demographics
NPI:1861177255
Name:HENNESSY MEDICAL PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:HENNESSY MEDICAL PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
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:973-402-1969
Practice Address - Street 1:223 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BOONTON
Practice Address - State:NJ
Practice Address - Zip Code:07005-1166
Practice Address - Country:US
Practice Address - Phone:973-402-1973
Practice Address - Fax:973-402-1969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-21
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty