Provider Demographics
NPI:1720543499
Name:MENENDEZ, JOEL (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:
Last Name:MENENDEZ
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2025 HAMBURG TPKE STE E
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-6250
Mailing Address - Country:US
Mailing Address - Phone:973-835-2827
Mailing Address - Fax:976-863-1856
Practice Address - Street 1:15 CORPORATE DR STE 6
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-3120
Practice Address - Country:US
Practice Address - Phone:973-368-4907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-06
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01840900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist