Provider Demographics
NPI:1104065283
Name:HENDEL, SHAUL (LAC)
Entity type:Individual
Prefix:
First Name:SHAUL
Middle Name:
Last Name:HENDEL
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 JENNISON AVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:NY
Mailing Address - Zip Code:13790-2302
Mailing Address - Country:US
Mailing Address - Phone:607-729-0591
Mailing Address - Fax:
Practice Address - Street 1:27 JENISON AVE
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:NY
Practice Address - Zip Code:13790-2302
Practice Address - Country:US
Practice Address - Phone:607-729-0591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-12
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001020-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist