Provider Demographics
NPI:1023185618
Name:TENENBAUM, VICTOR L (DO)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:L
Last Name:TENENBAUM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:188 E 78TH ST
Mailing Address - Street 2:APT 16C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-0406
Mailing Address - Country:US
Mailing Address - Phone:212-772-1603
Mailing Address - Fax:718-209-1161
Practice Address - Street 1:1995 ROCKAWAY PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-5505
Practice Address - Country:US
Practice Address - Phone:718-251-1661
Practice Address - Fax:718-209-1161
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY149717207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB14939Medicare UPIN