Provider Demographics
NPI:1588668479
Name:TANENBAUM, SHEILA (MD)
Entity Type:Individual
Prefix:DR
First Name:SHEILA
Middle Name:
Last Name:TANENBAUM
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 1:1270 NORTH AVE
Mailing Address - Street 2:# P-1
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10804-2601
Mailing Address - Country:US
Mailing Address - Phone:914-633-1644
Mailing Address - Fax:914-633-3152
Practice Address - Street 1:1270 NORTH AVE
Practice Address - Street 2:# P-1
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10804-2601
Practice Address - Country:US
Practice Address - Phone:914-633-1644
Practice Address - Fax:914-633-3152
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-08
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY099091208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00169195Medicaid
NY00169195Medicaid
NY843511Medicare ID - Type Unspecified