Provider Demographics
NPI:1093873267
Name:TANENBAUM, JUDITH HERTZ (MD)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:HERTZ
Last Name:TANENBAUM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JUDITH
Other - Middle Name:ELLEN
Other - Last Name:HERTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:930 PARK AVE
Mailing Address - Street 2:SUITE 1C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-0209
Mailing Address - Country:US
Mailing Address - Phone:212-744-4818
Mailing Address - Fax:212-744-4068
Practice Address - Street 1:930 PARK AVE
Practice Address - Street 2:SUITE 1C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-0209
Practice Address - Country:US
Practice Address - Phone:212-744-4818
Practice Address - Fax:212-744-4068
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1809622084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY70K302Medicare ID - Type UnspecifiedOPTED OUT