MEDICARE: JOSHUA C FENDEL M.S. (SOCIAL WORK)

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	LCSW R008493	NY

General Provider Information

NPI Number	:	1538181664
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSHUA C FENDEL M.S. (SOCIAL WORK)

Provider Business Mailing Address
First Line	:	53 SALEM RIDGE DR
Second Line	:
City	:	HUNTINGTON
State	:	NY
Zip	:	11743-3018
Country	:	US
Telephone Number	:	631-351-2940
Fax Number	:	631-351-1105

Provider Business Practice Location Address
First Line	:	301 E MAIN ST
Second Line	:
City	:	CENTERPORT
State	:	NY
Zip	:	11721-1439
Country	:	US
Telephone Number	:	631-351-2940
Fax Number	:	631-824-9369

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	11/30/2009

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