Provider Demographics
NPI:1902194939
Name:GENDREAU, JOANNA LYNN (DO)
Entity Type:Individual
Prefix:DR
First Name:JOANNA
Middle Name:LYNN
Last Name:GENDREAU
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JOANNA
Other - Middle Name:LYNN
Other - Last Name:WIGFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:309 GOLD ST APT 5B
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-1274
Mailing Address - Country:US
Mailing Address - Phone:330-605-4004
Mailing Address - Fax:
Practice Address - Street 1:161 FORT WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3729
Practice Address - Country:US
Practice Address - Phone:212-305-9770
Practice Address - Fax:212-305-5848
Is Sole Proprietor?:No
Enumeration Date:2011-07-12
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0062762080P0207X, 208000000X
390200000X
NY3126652080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program