Provider Demographics
NPI:1447228002
Name:MAENDEL, CHRISTOPHER MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:MICHAEL
Last Name:MAENDEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 MAPLE RIDGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:ULSTER PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12487
Mailing Address - Country:US
Mailing Address - Phone:845-339-6680
Mailing Address - Fax:
Practice Address - Street 1:1001 BROADWAY
Practice Address - Street 2:SUITE 223
Practice Address - City:ULSTER PARK
Practice Address - State:NY
Practice Address - Zip Code:12487-5209
Practice Address - Country:US
Practice Address - Phone:845-339-6680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD061934L207Q00000X
NY202940-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA122177OtherUNISON OB
PA0018500920003Medicaid
PA120204OtherUNISON PCP
PA122177OtherUNISON OB
PA0018500920003Medicaid