Healthcare Provider Details

I. General information

NPI: 1760459036
Provider Name (Legal Business Name): NATHAN H MAENDEL RPAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2006
Last Update Date: 07/26/2021
Certification Date: 07/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 HELLBROOK LN
ULSTER PARK NY
12487-5209
US

IV. Provider business mailing address

10 HELLBROOK LN
ULSTER PARK NY
12487-5209
US

V. Phone/Fax

Practice location:
  • Phone: 845-658-7763
  • Fax:
Mailing address:
  • Phone: 845-658-7763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number003828
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: