Provider Demographics
NPI:1538181664
Name:FENDEL, JOSHUA C (MS (SOCIAL WORK))
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:C
Last Name:FENDEL
Suffix:
Gender:M
Credentials:MS (SOCIAL WORK)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 SALEM RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-3018
Mailing Address - Country:US
Mailing Address - Phone:631-351-2940
Mailing Address - Fax:631-351-1105
Practice Address - Street 1:301 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CENTERPORT
Practice Address - State:NY
Practice Address - Zip Code:11721-1439
Practice Address - Country:US
Practice Address - Phone:631-351-2940
Practice Address - Fax:631-824-9369
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYLCSW R0084931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN26731Medicare PIN