MEDICARE: SVETLANA TENENBAUM MPH, CDN, IBCLC

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	133V00000X	Registered Dietitian	005462	NY

General Provider Information

NPI Number	:	1073006250
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SVETLANA TENENBAUM MPH, CDN, IBCLC

Provider Business Mailing Address
First Line	:	2703 E 28TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-2409
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2703 E 28TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-2409
Country	:	US
Telephone Number	:	718-648-0042
Fax Number	:

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

Provider Enumeration Date	:	06/12/2018
Last Update Date	:	06/12/2018

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