Provider Demographics
NPI:1124337167
Name:TANNENBAUM, SARAH
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:TANNENBAUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 50TH AVE
Mailing Address - Street 2:#2L
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-5739
Mailing Address - Country:US
Mailing Address - Phone:404-932-3728
Mailing Address - Fax:
Practice Address - Street 1:201 50TH AVE
Practice Address - Street 2:#2L
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-5739
Practice Address - Country:US
Practice Address - Phone:404-932-3728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-24
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program