MEDICARE: MR. DAVID A FENDEL LMSW

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	104100000X	Social Worker	125911-01	NY

General Provider Information

NPI Number	:	1689479107
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVID A FENDEL LMSW

Provider Business Mailing Address
First Line	:	458 E 2ND ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11218-4504
Country	:	US
Telephone Number	:	917-225-3686
Fax Number	:

Provider Business Practice Location Address
First Line	:	458 E 2ND ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11218-4504
Country	:	US
Telephone Number	:	917-225-3686
Fax Number	:

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

Provider Enumeration Date	:	02/18/2025
Last Update Date	:	02/18/2025

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