Provider Demographics
NPI:1548511744
Name:FENELUS, JOSUE (LPN)
Entity type:Individual
Prefix:MR
First Name:JOSUE
Middle Name:
Last Name:FENELUS
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 EDISON CT
Mailing Address - Street 2:APT D
Mailing Address - City:MONSEY
Mailing Address - State:NY
Mailing Address - Zip Code:10952-1941
Mailing Address - Country:US
Mailing Address - Phone:845-517-4578
Mailing Address - Fax:
Practice Address - Street 1:102 EDISON CT
Practice Address - Street 2:APT D
Practice Address - City:MONSEY
Practice Address - State:NY
Practice Address - Zip Code:10952-1941
Practice Address - Country:US
Practice Address - Phone:845-558-5201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-27
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY309180-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse