1447490917 NPI number — DR. AMY BETH TANNENBAUM D.D.S.

Table of content: DR. AMY BETH TANNENBAUM D.D.S. (NPI 1447490917)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447490917 NPI number — DR. AMY BETH TANNENBAUM D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TANNENBAUM
Provider First Name:
AMY
Provider Middle Name:
BETH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.D.S.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447490917
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/24/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
64 DIVISION AVE
Provider Second Line Business Mailing Address:
SUITE 215C
Provider Business Mailing Address City Name:
LEVITTOWN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11756
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-644-2218
Provider Business Mailing Address Fax Number:
516-644-2219

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1644 DEER PARK AVE.
Provider Second Line Business Practice Location Address:
PARK HILLS DENTAL CENTER
Provider Business Practice Location Address City Name:
DEER PARK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11729
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-586-7100
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/24/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  051766 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)