Provider Demographics
NPI:1306189113
Name:MAENDEL, TOBIAS (LAC)
Entity Type:Individual
Prefix:
First Name:TOBIAS
Middle Name:
Last Name:MAENDEL
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 BERGEN ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11216-2904
Mailing Address - Country:US
Mailing Address - Phone:347-512-4960
Mailing Address - Fax:
Practice Address - Street 1:816 8TH AVENUE
Practice Address - Street 2:SLOPE WELLNESS ACUPUNCTURE PLLC
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215
Practice Address - Country:US
Practice Address - Phone:347-512-4960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-29
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY25 004397171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist