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General NPI Number Information
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NPI Number | 1821103813
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Entity Type | Organization
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Legal Business Name | MICHAEL TENENBAUM
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Dates
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Enumeration Date | 08/20/2006
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Last Update Date | 03/10/2021
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Provider Practice Location Address
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Address Line | 430 BEACH 68TH ST
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City | ARVERNE
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State | NY
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Zip | 11692-1407
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Country | US
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Telephone | 718-474-5200
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Fax | 718-474-5214
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Provider Business Mailing Address
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Address Line | 430 BEACH 68TH ST
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City | ARVERNE
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State | NY
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Zip | 11692-1407
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Country | US
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Telephone | 718-474-5200
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Fax | 718-474-5214
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JACOB PERLES
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Credential |
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Telephone | 718-474-5200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 7003330N
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License Number State | NY
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