Provider Demographics
NPI:1760459036
Name:MAENDEL, NATHAN H (RPAC)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:H
Last Name:MAENDEL
Suffix:
Gender:M
Credentials:RPAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 HELLBROOK LN
Mailing Address - Street 2:
Mailing Address - City:ULSTER PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12487-5209
Mailing Address - Country:US
Mailing Address - Phone:845-658-7763
Mailing Address - Fax:
Practice Address - Street 1:10 HELLBROOK LN
Practice Address - Street 2:
Practice Address - City:ULSTER PARK
Practice Address - State:NY
Practice Address - Zip Code:12487-5209
Practice Address - Country:US
Practice Address - Phone:845-658-7763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-04
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003828363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01734963Medicaid
NY225179OtherHMO - ELKA PARK
NY01734963Medicaid
NY0F1621Medicare ID - Type Unspecified
NY225179OtherHMO - ELKA PARK