Provider Demographics
NPI:1912927047
Name:TANNENBAUM, BENJAMIN (DC, FNP)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:
Last Name:TANNENBAUM
Suffix:
Gender:M
Credentials:DC, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 PLYMOUTH ST
Mailing Address - Street 2:
Mailing Address - City:WEST HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11552-2436
Mailing Address - Country:US
Mailing Address - Phone:516-385-6408
Mailing Address - Fax:
Practice Address - Street 1:496 SMITHTOWN BYP STE 200
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-5011
Practice Address - Country:US
Practice Address - Phone:631-361-5300
Practice Address - Fax:631-361-5301
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2018-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX011198111N00000X
NY342001363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No111N00000XChiropractic ProvidersChiropractor