Provider Demographics
NPI:1952758062
Name:MENDELBLATT, BRENDT
Entity type:Individual
Prefix:
First Name:BRENDT
Middle Name:
Last Name:MENDELBLATT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 BARDONIA RD
Mailing Address - Street 2:
Mailing Address - City:BARDONIA
Mailing Address - State:NY
Mailing Address - Zip Code:10954-2123
Mailing Address - Country:US
Mailing Address - Phone:845-623-1558
Mailing Address - Fax:845-623-6437
Practice Address - Street 1:28 BARDONIA RD
Practice Address - Street 2:
Practice Address - City:BARDONIA
Practice Address - State:NY
Practice Address - Zip Code:10954-2123
Practice Address - Country:US
Practice Address - Phone:845-623-1558
Practice Address - Fax:845-623-6437
Is Sole Proprietor?:No
Enumeration Date:2016-05-18
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX0 012837111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor