1396805909 NPI number — MOISES TENEMBAUM MD & MICHAEL DREW MD PLLC

Table of content: MRS. ANNE C. H. ETHIER LPC (NPI 1477837755)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396805909 NPI number — MOISES TENEMBAUM MD & MICHAEL DREW MD PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOISES TENEMBAUM MD & MICHAEL DREW MD PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1396805909
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7010 AUSTIN ST
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
FOREST HILLS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11375-4763
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-575-9595
Provider Business Mailing Address Fax Number:
718-575-8456

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7010 AUSTIN ST
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
FOREST HILLS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11375-4763
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-575-9595
Provider Business Practice Location Address Fax Number:
718-575-8456
Provider Enumeration Date:
12/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DREW
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
MD
Authorized Official Telephone Number:
718-575-9595

Provider Taxonomy Codes

  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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