MEDICARE: DR. MARK TANENBAUM D.P.M.

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	213E00000X	Podiatrist	N003136	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689656399
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK TANENBAUM D.P.M.

Provider Business Mailing Address
First Line	:	415 E 52ND ST
Second Line	:	APT 7BC
City	:	NEW YORK
State	:	NY
Zip	:	10022-9033
Country	:	US
Telephone Number	:	718-627-0585
Fax Number	:	718-228-4930

Provider Business Practice Location Address
First Line	:	1648 E 14TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-1175
Country	:	US
Telephone Number	:	718-627-0585
Fax Number	:	718-228-4930

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

Provider Enumeration Date	:	11/17/2005
Last Update Date	:	04/28/2016

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