NPIMap

Individual provider Active NPI

Jean M Henneberry, MD

  • Anatomic Pathology & Clinical Pathology Physician
  • Tarrytown, NY
National Provider Identifier
1295836195
Registry record updated Jan 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
53620 Issued in CT
Practice address
560 White Plains Rd FL 6
Tarrytown, NY 10591-5155
Phone
(914) 345-1100
Fax
(914) 345-1101
NPI assigned
Sep 26, 2006
Last updated
Jan 29, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 29, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatopathology (Pathology) Physician 207ZD0900X 156584 MA
Dermatopathology (Pathology) Physician 207ZD0900X 53620 CT
Dermatopathology (Pathology) Physician 207ZD0900X 323463 NY
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X 53620 CT Primary

Addresses

Primary practice location

560 White Plains Rd FL 6
Tarrytown, NY 10591-5155

Mailing address

560 White Plains Rd FL 6
Tarrytown, NY 10591-5155
Phone (914) 345-1100

Other practice location 1

80 Seymour St
Hartford, CT 06102-8000
Phone (860) 545-5000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA, CT2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20080609000838 MA Practitioner - Pathology 7810067410 Reassigns benefits to 2 organizations
I20250122002736 CT Practitioner - Pathology 7810067410 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pathology
Education
University of Texas Southwestern Medical School at Dallas, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hartford Pathology Associates PCGroup PAC ID 8729989561, 29 clinicians

Practice addresses (Care Compare)

80 Seymour St
Pathology Dept
Hartford, CT 06141-0540
Phone (860) 545-2249

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
156584MAMDDermatopathology (Pathology) Physician
323463NYMDDermatopathology (Pathology) Physician
53620CTMDAnatomic Pathology & Clinical Pathology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Englewood Pathologists, PA Dermatopathology CurrentSince Sep 20, 2023 Accepting new patients
Hartford Pathology Associates, P.C. Anatomic Pathology & Clinical Pathology CurrentSince Jan 1, 2025 Accepting new patients
Bridge Dermatopathology Services PLLC CurrentSince Oct 1, 2023 Accepting new patients
New England Dermatology, P.C. CurrentSince Mar 17, 2019 Accepting new patients
Pioneer Valley Urology, PC CurrentSince Jul 6, 1998 Accepting new patients
Hartford Hospital Current Accepting new patients
Radiology & Imaging Inc Past Accepting new patients

Locations

80 Seymour St
Hartford, CT 06106
Phone (860) 545-2249

99 E River Dr
Fl 5
Hartford, CT 06108
Phone (860) 282-4022

100 Wason Ave
Ste 120
Springfield, MA 01107
Phone (413) 241-2100

3455 Main St
Ste 5
Springfield, MA 01107
Phone (413) 733-9600

350 Engle St
Englewood, NJ 07631
Phone (201) 871-6073

25 Riverside Dr
Ste 2
Pine Brook, NJ 07058
Phone (201) 599-9044

560 White Plains Rd
Fl 6
Tarrytown, NY 10591
Phone (914) 345-1100

Interoperability endpoints

  • FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.140.60885

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 10

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738108800000",
    "number": "1295836195",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "560 WHITE PLAINS RD FL 6",
            "city": "TARRYTOWN",
            "state": "NY",
            "postal_code": "105915155",
            "telephone_number": "914-345-1100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "560 WHITE PLAINS RD FL 6",
            "city": "TARRYTOWN",
            "state": "NY",
            "postal_code": "105915155",
            "telephone_number": "914-345-1100",
            "fax_number": "914-345-1101"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "80 Seymour St",
            "address_purpose": "LOCATION",
            "city": "Hartford",
            "state": "CT",
            "postal_code": "061028000",
            "country_code": "US",
            "telephone_number": "860-545-5000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HENNEBERRY",
        "first_name": "JEAN",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-26",
        "last_updated": "2025-01-29",
        "certification_date": "2025-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZD0900X",
            "taxonomy_group": "",
            "desc": "Pathology, Dermatopathology",
            "state": "MA",
            "license": "156584",
            "primary": false
        },
        {
            "code": "207ZD0900X",
            "taxonomy_group": "",
            "desc": "Pathology, Dermatopathology",
            "state": "CT",
            "license": "53620",
            "primary": false
        },
        {
            "code": "207ZD0900X",
            "taxonomy_group": "",
            "desc": "Pathology, Dermatopathology",
            "state": "NY",
            "license": "323463",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "CT",
            "license": "53620",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tarrytown, NY

Sources for this page

Verify at the official NPI Registry.