Individual
DR. ALICE SUSAN TANNENBAUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1 MALCOLM AVE, TETERBORO, NJ 07608-1011
(201) 393-5589
Mailing address
338 W 72ND ST, APT 1, NEW YORK, NY 10023-2643
(212) 874-2772
Taxonomy
Speciality
Code
Description
License number
State
207ZP0101X
Anatomic Pathology Physician
108607
NY
207ZP0101X
Anatomic Pathology Physician
Primary
25MA03879100
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03181495
—
NY
Enumeration date
08/19/2008
Last updated
05/24/2010
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