Jonathan Edward Hendrzak, DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

HEND-GK3L8H Issued in NC

Practice address

2131 S 17TH St
Wilmington, NC 28401-7407

Phone

(910) 343-7000

Fax

(910) 667-5650

NPI assigned

Mar 25, 2022

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

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

{
    "created_epoch": "1648166400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1680048000000",
    "number": "1639829377",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2523 DELANEY AVE",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284036003",
            "telephone_number": "910-763-5522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2131 S 17TH ST",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284017407",
            "telephone_number": "910-343-7000",
            "fax_number": "910-667-5650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDRZAK",
        "first_name": "JONATHAN",
        "middle_name": "EDWARD",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-03-25",
        "last_updated": "2023-03-29",
        "certification_date": "2023-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NC",
            "license": "HEND-GK3L8H",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "HEND-GK3L8H",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Heather Marie Henderson
• Lauren Henderson, RBT
• Michael Henderson, PH.D., LBA, BCBA-D
• Rachel Hendricks, LCSW
• Jason L Hendrix, OD
• Robert DJ Henihan, M.D.
• Linda Shaw Henley, LPCA
• Susan Elaine Henley, LCSW
• Pamela Jane Henning, LCMHC
• Robyn Henning

• Family Medicine Physician in Wilmington, NC
• Providers in Wilmington, NC by specialty
• Family Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.