NPIMap

Organization Active NPI

Theodore C.Docu MD, PC

  • Internal Medicine Physician
National Provider Identifier
1730304270
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
182886 Issued in NY
Legal business name
THEODORE C.DOCU MD, PC
Practice address
506 Fort Washington Ave 1F
1F
New York,Ny, NY 10033
UM
Phone
(212) 568-0553
NPI assigned
Apr 17, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Theodore Costa Docu, M.DNPI 1326084856
Title
President
Phone
(212) 568-0553

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X 182886 NY Primary

Addresses

Primary practice location

506 Fort Washington Ave 1F
1F
New York,Ny, NY 10033
UM

Mailing address

506 Fort Washington Ave 1F
1F
New York,Ny, NY 10033
UM
Phone (212) 568-0553

Other identifiers 1

IdentifierTypeStateIssuer
01189151MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070419000411 NY Part B Supplier - Clinic/Group Practice 6002911070 Receives reassigned benefits from 5 practitioners
Practice locations: Bronx, NY; New York, NY

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176768000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1730304270",
    "addresses": [
        {
            "country_code": "UM",
            "country_name": "United States Minor Outlying Islands",
            "address_purpose": "MAILING",
            "address_type": "FGN",
            "address_1": "506 FORT WASHINGTON AVE 1F",
            "address_2": "1F",
            "city": "NEW YORK,NY",
            "state": "NY",
            "postal_code": "10033",
            "telephone_number": "212-568-0553"
        },
        {
            "country_code": "UM",
            "country_name": "United States Minor Outlying Islands",
            "address_purpose": "LOCATION",
            "address_type": "FGN",
            "address_1": "506 FORT WASHINGTON AVE 1F",
            "address_2": "1F",
            "city": "NEW YORK,NY",
            "state": "NY",
            "postal_code": "10033",
            "telephone_number": "212-568-0553"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THEODORE C.DOCU MD, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-17",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DOCU",
        "authorized_official_first_name": "THEODORE",
        "authorized_official_middle_name": "COSTA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "212-568-0553",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "182886",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01189151",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.