Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223G0001X | General Practice | 22DI02475500 | NJ |
N | 213EG0000X | General Practice | 22DI02475500 | NJ |
N | 1223P0221X | Pediatric Dentist | 055625 | NY |
Y | 1223P0221X | Pediatric Dentist | 22DI02475500 | NJ |
NPI | 1053609974 |
---|---|
Provider Name | Dr. Tamar Gruenbaum |
First Address | Bronx, NY 10471-3611 |
Second Address | Glen Rock, NJ 07452-1543 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2011 |
Last Update Date | 29/10/2015 |