Provider Demographics
NPI:1033681465
Name:GENDLER, YAKOV (DPT)
Entity Type:Individual
Prefix:
First Name:YAKOV
Middle Name:
Last Name:GENDLER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7-04 ELAINE TER
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-5710
Mailing Address - Country:US
Mailing Address - Phone:347-409-5754
Mailing Address - Fax:
Practice Address - Street 1:7-04 ELAINE TER
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-5710
Practice Address - Country:US
Practice Address - Phone:347-409-5754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-25
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043872-1225100000X
NJ40QA02049000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist