Provider Demographics
NPI:1124041827
Name:TENNENBAUM, STEVEN Y (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:Y
Last Name:TENNENBAUM
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 1:699 TEANECK RD
Mailing Address - Street 2:ROOM 103
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-4244
Mailing Address - Country:US
Mailing Address - Phone:201-692-9550
Mailing Address - Fax:201-692-1363
Practice Address - Street 1:699 TEANECK RD
Practice Address - Street 2:ROOM 103
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-4244
Practice Address - Country:US
Practice Address - Phone:201-692-9550
Practice Address - Fax:201-692-1363
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1656842086S0120X, 208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
No208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01255898Medicaid
NY86F62OtherBLUE SHIELD
NYGS333OtherOXFORD
NY1000042OtherGHI
NY2C1363OtherHEALTHNET
NY4225633OtherAETNA/U.S.HEALTHCARE
NYGS333OtherOXFORD