Provider Demographics
NPI:1053371765
Name:JANSSEN, HENRY HERMAN JR (MD)
Entity type:Individual
Prefix:
First Name:HENRY
Middle Name:HERMAN
Last Name:JANSSEN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 S BEDFORD RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-3446
Mailing Address - Country:US
Mailing Address - Phone:914-241-1050
Mailing Address - Fax:
Practice Address - Street 1:90 S BEDFORD RD
Practice Address - Street 2:
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-3412
Practice Address - Country:US
Practice Address - Phone:914-241-1050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-25
Last Update Date:2017-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0377512085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT300128165OtherRAILROAD MEDICARE
CT010037751CT14OtherANTHEM BC/BS
CT300128159OtherRAILROAD MEDICARE
CT001377515Medicaid
CT300128163OtherRAILROAD MEDICARE
CT010037751CT06OtherANTHEM BC/BS
CT010037751CT07OtherANTHEM BC/BS
CT010037751CT12OtherANTHEM BC/BS
CTP00124616OtherRAILROAD MEDICARE
CT010037751CT10OtherANTHEM BC/BS
CT010037751CT10OtherANTHEM BC/BS
CT300128159OtherRAILROAD MEDICARE
CT010037751CT14OtherANTHEM BC/BS
CT300128165OtherRAILROAD MEDICARE
CT010037751CT12OtherANTHEM BC/BS
CTH09472Medicare UPIN
CT300003179Medicare PIN
CT300003178Medicare PIN