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Individual

DR. MARK TANENBAUM

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
D.P.M.

Contact information

Practice address
1648 E 14TH ST, BROOKLYN, NY 11229-1175
(718) 627-0585
(718) 228-4930
Mailing address
415 E 52ND ST, APT 7BC, NEW YORK, NY 10022-9033
(718) 627-0585
(718) 228-4930

Taxonomy

Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
N003136
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00540987
NY
Enumeration date
11/17/2005
Last updated
04/28/2016
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