Provider Demographics
NPI:1649270836
Name:TANNENBAUM, JOSHUA (MD)
Entity type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:
Last Name:TANNENBAUM
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 1:45 E 85TH ST
Mailing Address - Street 2:SUITE 1E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-0957
Mailing Address - Country:US
Mailing Address - Phone:212-737-4278
Mailing Address - Fax:212-737-4031
Practice Address - Street 1:45 E 85TH ST
Practice Address - Street 2:SUITE 1E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-0957
Practice Address - Country:US
Practice Address - Phone:212-737-4278
Practice Address - Fax:212-737-4031
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY137025207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB13806Medicare UPIN
NY36D533Medicare ID - Type Unspecified