Provider Demographics
NPI:1134312606
Name:KANDEL, HENRY JAMES (PHD)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:JAMES
Last Name:KANDEL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 PALISADE AVE
Mailing Address - Street 2:SUITE 18D
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-4135
Mailing Address - Country:US
Mailing Address - Phone:201-699-0128
Mailing Address - Fax:
Practice Address - Street 1:184 E NORTHFIELD RD
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-4503
Practice Address - Country:US
Practice Address - Phone:973-533-6999
Practice Address - Fax:973-533-6998
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-19
Last Update Date:2007-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100276600103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP19572Medicare PIN