Individual
DR. JORDAN M TANNENBAUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1 FOX CARE DR, STE 213, ONEONTA, NY 13820-2086
(607) 432-5600
(607) 431-5275
Mailing address
1 FOX CARE DR, STE 213, ONEONTA, NY 13820-2086
(607) 432-5600
(607) 431-5275
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
149788
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00279098
—
NY
01
—
002892901
BLUE CROSS BLUE SHIELD
NY
Enumeration date
06/01/2005
Last updated
06/29/2010
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