Provider Demographics
NPI:1235214669
Name:AGARD-HENRIQUES, BERNADETTE NADIRA (MD)
Entity type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:NADIRA
Last Name:AGARD-HENRIQUES
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 1:1 WHITTIER AVE
Mailing Address - Street 2:
Mailing Address - City:CORTLANDT MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10567-4208
Mailing Address - Country:US
Mailing Address - Phone:845-514-9432
Mailing Address - Fax:
Practice Address - Street 1:11835 QUEENS BLVD STE 400
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-7211
Practice Address - Country:US
Practice Address - Phone:646-722-7610
Practice Address - Fax:347-535-3970
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT79040207RG0300X
NY211746207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02090917Medicaid
NY07S311Medicare ID - Type Unspecified
NY02090917Medicaid