Provider Demographics
NPI:1588747521
Name:TANNENBAUM, ALAN KEITH (MD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:KEITH
Last Name:TANNENBAUM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:18 CENTRE DRIVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:MONROE TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-3260
Mailing Address - Country:US
Mailing Address - Phone:609-395-7600
Mailing Address - Fax:609-395-7559
Practice Address - Street 1:10 PLUM STREET
Practice Address - Street 2:UNIVERSITY RADIOLOGY AT ROBERT WOOD JOHNSON LLC
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901
Practice Address - Country:US
Practice Address - Phone:732-249-4410
Practice Address - Fax:732-249-1208
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2010-04-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJMA048977174400000X
NJ25MA04897700207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No174400000XOther Service ProvidersSpecialist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ060015491OtherRR MEDICARE PTAN
NJ1092802OtherHORIZON NJ HEALTH
NJ15634OtherUNIVERSITY HEALTH PLANS
NJF04685OtherHEALTHNET
NJ060015491OtherRR MCR PTAN
NJM10000542 01OtherAMERICHOICE
NJ29269OtherBEECH STREET
NJ0626708Medicaid
NJ18141OtherAMERIGROUP
NJC35173Medicare UPIN
NJ15634OtherUNIVERSITY HEALTH PLANS