Provider Demographics
NPI:1538277652
Name:MENENDEZ, JOSEPH A (PT, MS)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:A
Last Name:MENENDEZ
Suffix:
Gender:M
Credentials:PT, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:713 WALT WHITMAN RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-2202
Mailing Address - Country:US
Mailing Address - Phone:631-425-5900
Mailing Address - Fax:631-424-9850
Practice Address - Street 1:713 WALT WHITMAN RD
Practice Address - Street 2:SUITE B
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-2202
Practice Address - Country:US
Practice Address - Phone:631-425-5900
Practice Address - Fax:631-424-9850
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY022752-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ00E31Medicare ID - Type Unspecified