Provider Demographics
NPI:1700836608
Name:TENENBAUM, MARVIN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:
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 1:100 PORT WASHINGTON BLVD.
Mailing Address - Street 2:ST. FRANCIS HOSPITAL
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576
Mailing Address - Country:US
Mailing Address - Phone:516-562-6154
Mailing Address - Fax:516-562-6797
Practice Address - Street 1:100 PORT WASHINGTON BLVD.
Practice Address - Street 2:ST. FRANCIS HOSPITAL
Practice Address - City:ROSLYN
Practice Address - State:NY
Practice Address - Zip Code:11576
Practice Address - Country:US
Practice Address - Phone:516-562-6154
Practice Address - Fax:516-562-6797
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY137752207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00981640Medicaid
NY00981640Medicaid
NYB19977Medicare UPIN