Provider Demographics
NPI:1467555052
Name:GENDLERMAN, JOSEF I (MD)
Entity Type:Individual
Prefix:
First Name:JOSEF
Middle Name:I
Last Name:GENDLERMAN
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 1:360 MERRIMACK ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01843-1740
Mailing Address - Country:US
Mailing Address - Phone:978-692-0930
Mailing Address - Fax:978-682-3138
Practice Address - Street 1:360 MERRIMACK ST
Practice Address - Street 2:SUITE #3
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01843
Practice Address - Country:US
Practice Address - Phone:978-682-0930
Practice Address - Fax:978-682-3138
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2012-11-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA59700207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C98442Medicare UPIN
J07420Medicare ID - Type Unspecified