Provider Demographics
NPI:1396805909
Name:MOISES TENEMBAUM MD & MICHAEL DREW MD PLLC
Entity type:Organization
Organization Name:MOISES TENEMBAUM MD & MICHAEL DREW MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DREW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-575-9595
Mailing Address - Street 1:7010 AUSTIN ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-4763
Mailing Address - Country:US
Mailing Address - Phone:718-575-9595
Mailing Address - Fax:718-575-8456
Practice Address - Street 1:7010 AUSTIN ST
Practice Address - Street 2:SUITE 103
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4763
Practice Address - Country:US
Practice Address - Phone:718-575-9595
Practice Address - Fax:718-575-8456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04592Medicare PIN
W86131Medicare PIN