Provider Demographics
NPI:1871613208
Name:HAROLD R TANENBAUM MD PC
Entity type:Organization
Organization Name:HAROLD R TANENBAUM MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:R
Authorized Official - Last Name:TANENBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-579-5579
Mailing Address - Street 1:33 KENSINGTON CIR
Mailing Address - Street 2:
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-4104
Mailing Address - Country:US
Mailing Address - Phone:718-579-5579
Mailing Address - Fax:718-579-4649
Practice Address - Street 1:57 W 57TH ST
Practice Address - Street 2:SUITE 512
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-2802
Practice Address - Country:US
Practice Address - Phone:212-319-9393
Practice Address - Fax:212-319-3770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY564962085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB88910Medicare UPIN