MEDICARE: SARAH TANNENBAUM

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1124337167
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH TANNENBAUM

Provider Business Mailing Address
First Line	:	201 50TH AVE
Second Line	:	#2L
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-5739
Country	:	US
Telephone Number	:	404-932-3728
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 50TH AVE
Second Line	:	#2L
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-5739
Country	:	US
Telephone Number	:	404-932-3728
Fax Number	:

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

Provider Enumeration Date	:	09/24/2010
Last Update Date	:	09/24/2010

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Directions to “ SARAH TANNENBAUM ” Practice Location

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