Provider Demographics
NPI:1699710814
Name:TENEMBAUM, MOISES M (MD)
Entity type:Individual
Prefix:DR
First Name:MOISES
Middle Name:M
Last Name:TENEMBAUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7010 AUSTIN ST
Mailing Address - Street 2:STE 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:STE 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
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY142059174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC10155Medicare UPIN
NY82L051Medicare ID - Type Unspecified