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General NPI Number Information
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NPI Number | 1588747521
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Entity Type | Individual
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Provider Name | ALAN KEITH TANNENBAUM M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 04/08/2010
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Provider Practice Location Address
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Address Line | 10 PLUM STREET UNIVERSITY RADIOLOGY AT ROBERT WOOD JOHNSON LLC
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City | NEW BRUNSWICK
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State | NJ
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Zip | 08901
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Country | US
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Telephone | 732-249-4410
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Fax | 732-249-1208
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Provider Business Mailing Address
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Address Line | 18 CENTRE DRIVE SUITE 205
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City | MONROE TOWNSHIP
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State | NJ
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Zip | 08831-3260
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Country | US
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Telephone | 609-395-7600
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Fax | 609-395-7559
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MA048977
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 25MA04897700
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 25MA04897700
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License Number State | NJ
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