Provider Demographics
NPI:1285518811
Name:HENRY HEALTH SERVICES NURSE PRACTITIONER IN ADULT HEALTH, PLLC
Entity type:Organization
Organization Name:HENRY HEALTH SERVICES NURSE PRACTITIONER IN ADULT HEALTH, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:347-477-7574
Mailing Address - Street 1:PO BOX 297215
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-7215
Mailing Address - Country:US
Mailing Address - Phone:347-477-7574
Mailing Address - Fax:
Practice Address - Street 1:1250 OCEAN PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-5155
Practice Address - Country:US
Practice Address - Phone:347-477-7574
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-05
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05851565Medicaid
NY309454OtherNP LICENSE NUMBER
1083256788OtherNPI
14604628OtherCAQH PROVIDER ID