Provider Demographics
NPI:1447368113
Name:TENENBOYM, ALEXANDER B (MD)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:B
Last Name:TENENBOYM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 NOTT ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12308-2589
Mailing Address - Country:US
Mailing Address - Phone:518-374-3123
Mailing Address - Fax:518-374-9711
Practice Address - Street 1:1201 NOTT ST
Practice Address - Street 2:SUITE 106
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12308-2589
Practice Address - Country:US
Practice Address - Phone:518-374-3123
Practice Address - Fax:518-374-9711
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY197718207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
197718OtherNO FAULT
RB4583OtherFIDELIS MEDICARE
2406T1OtherEMPIRE BLUE CROSS
2406T2OtherEMPIRE BLUE CROSS
070807000042OtherFIDELIS CARE NY
NY01563299Medicaid
05034OtherMVP
10002030OtherCDPHP
000405121012OtherBLUE SHIELD NENY
2406T3OtherEMPIRE BLUE CROSS
000000006183OtherGHI
197718OtherTRICARE
E76784OtherAMERICAN PROGRESSIVE TODA
197718OtherWORKERS COMP
5301141OtherGHI
E76784Medicare UPIN
P00416608Medicare PIN
05034OtherMVP