Provider Demographics
NPI:1780902627
Name:WENDEL, IAN (DO)
Entity type:Individual
Prefix:DR
First Name:IAN
Middle Name:
Last Name:WENDEL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:532 LAFAYETTE RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SPARTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07871-4411
Mailing Address - Country:US
Mailing Address - Phone:973-940-0423
Mailing Address - Fax:973-940-0399
Practice Address - Street 1:532 LAFAYETTE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871-4411
Practice Address - Country:US
Practice Address - Phone:973-383-3730
Practice Address - Fax:973-383-2285
Is Sole Proprietor?:No
Enumeration Date:2010-05-16
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NJ25MB09488000208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program