MEDICARE: DR. DONALD R TANENBAUM DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	0371171	NY

General Provider Information

NPI Number	:	1134132640
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DONALD R TANENBAUM DDS

Provider Business Mailing Address
First Line	:	630 5TH AVE
Second Line	:	STE 1857
City	:	NEW YORK
State	:	NY
Zip	:	10111
Country	:	US
Telephone Number	:	212-265-0110
Fax Number	:	212-265-1767

Provider Business Practice Location Address
First Line	:	630 5TH AVE
Second Line	:	STE 1857
City	:	NEW YORK
State	:	NY
Zip	:	10111
Country	:	US
Telephone Number	:	212-265-0110
Fax Number	:	212-265-1767

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/14/2006
Last Update Date	:	07/08/2007

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