Provider Demographics
NPI:1710241690
Name:FENDRICH, CHANA LEAH
Entity Type:Individual
Prefix:MRS
First Name:CHANA
Middle Name:LEAH
Last Name:FENDRICH
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:HANNAH
Other - Middle Name:LEAH
Other - Last Name:FENDRICH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:14721 72ND DR
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-2545
Mailing Address - Country:US
Mailing Address - Phone:718-263-1055
Mailing Address - Fax:
Practice Address - Street 1:7238 MAIN ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-2408
Practice Address - Country:US
Practice Address - Phone:718-851-3300
Practice Address - Fax:718-261-3702
Is Sole Proprietor?:No
Enumeration Date:2012-06-26
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator