Healthcare Provider Details

I. General information

NPI: 1770447674
Provider Name (Legal Business Name): KATHERINE CORBETT WENDELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATIE CORBETT WENDELL PA-C

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 E 64TH ST
NEW YORK NY
10065-7471
US

IV. Provider business mailing address

330 W 15TH ST APT 3B
NEW YORK NY
10011-5962
US

V. Phone/Fax

Practice location:
  • Phone: 212-434-4263
  • Fax:
Mailing address:
  • Phone: 518-932-9643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: