Provider Demographics
NPI:1215201348
Name:TANNENBAUM, HODY LYON (MS CGC)
Entity Type:Individual
Prefix:
First Name:HODY
Middle Name:LYON
Last Name:TANNENBAUM
Suffix:
Gender:F
Credentials:MS CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 E 149TH ST
Mailing Address - Street 2:5D-203
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10451-5504
Mailing Address - Country:US
Mailing Address - Phone:718-579-5295
Mailing Address - Fax:718-579-4640
Practice Address - Street 1:234 E 149TH ST
Practice Address - Street 2:5D-203
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-5504
Practice Address - Country:US
Practice Address - Phone:718-579-5295
Practice Address - Fax:718-579-4640
Is Sole Proprietor?:No
Enumeration Date:2012-03-07
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS