Provider Demographics
NPI:1689721078
Name:TANENBAUM, HAROLD R (MD)
Entity Type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:R
Last Name:TANENBAUM
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 1:33 KENSINGTON CIR
Mailing Address - Street 2:
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-4104
Mailing Address - Country:US
Mailing Address - Phone:917-754-8363
Mailing Address - Fax:
Practice Address - Street 1:33 KENSINGTON CIR
Practice Address - Street 2:
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-4104
Practice Address - Country:US
Practice Address - Phone:917-754-8363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1515472085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology