Provider Demographics
NPI:1689702375
Name:TENENBAUM, STEVEN JAY (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:JAY
Last Name:TENENBAUM
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 1:8 WILLOW BROOK LN
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06470-1925
Mailing Address - Country:US
Mailing Address - Phone:203-270-1044
Mailing Address - Fax:
Practice Address - Street 1:41 GERMANTOWN RD
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-4087
Practice Address - Country:US
Practice Address - Phone:203-207-3300
Practice Address - Fax:203-207-3310
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT027120261QC1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health