Provider Demographics
NPI:1437254786
Name:TETENBAUM, CAROL E (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:E
Last Name:TETENBAUM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 POST RD
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-5007
Mailing Address - Country:US
Mailing Address - Phone:914-428-0503
Mailing Address - Fax:914-428-0825
Practice Address - Street 1:810 POST RD
Practice Address - Street 2:
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-5007
Practice Address - Country:US
Practice Address - Phone:914-428-0503
Practice Address - Fax:914-428-0825
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2014-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY160379207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA64306Medicare UPIN