Provider Demographics
NPI:1013696970
Name:TANNENBAUM, KARINNA
Entity Type:Individual
Prefix:MS
First Name:KARINNA
Middle Name:
Last Name:TANNENBAUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ADIRA
Other - Middle Name:
Other - Last Name:TANNENBAUM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1741 MARINE PKWY APT B
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-4451
Mailing Address - Country:US
Mailing Address - Phone:718-306-2897
Mailing Address - Fax:
Practice Address - Street 1:5309 18TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-1523
Practice Address - Country:US
Practice Address - Phone:718-705-5190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program