Provider Demographics
NPI:1477767978
Name:TANENHAUS, JINI (PA-C)
Entity Type:Individual
Prefix:MS
First Name:JINI
Middle Name:
Last Name:TANENHAUS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:558 10TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-4402
Mailing Address - Country:US
Mailing Address - Phone:718-788-1031
Mailing Address - Fax:212-274-7218
Practice Address - Street 1:26 BLEECKER ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-2413
Practice Address - Country:US
Practice Address - Phone:212-274-7340
Practice Address - Fax:212-274-7218
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00384-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant