TD Advanced Medical PC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

TD ADVANCED MEDICAL PC

Practice address

11054 Springfield Blvd
Queens Village, NY 11429-2521

Phone

(718) 740-4984

NPI assigned

Feb 5, 2010

Organization subpart

No

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

Authorized official

Name

Dr. Leslie Theodore

Title

President

Phone

(718) 740-4984

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1265328000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1265328000000",
    "number": "1760714349",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "683 HALF HOLLOW RD",
            "city": "DIX HILLS",
            "state": "NY",
            "postal_code": "117466232"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11054 SPRINGFIELD BLVD",
            "city": "QUEENS VILLAGE",
            "state": "NY",
            "postal_code": "114292521",
            "telephone_number": "718-740-4984"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TD ADVANCED MEDICAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-05",
        "last_updated": "2010-02-05",
        "status": "A",
        "authorized_official_last_name": "THEODORE",
        "authorized_official_first_name": "LESLIE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "718-740-4984",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jerome Tabaosares
• Sanije Tabares
• Ariel Taniajura, PT
• Fitzgerald Tardieu
• Gwendolyn Taylor, LMSW
• Jennifer Tello
• Joni Lynn Velasco Tello, RPT
• Winnie Tema
• Aleksey Ten, MD
• Neil Jason Teves, PT

• Internal Medicine Physician in Queens Village, NY
• Providers in Queens Village, NY by specialty
• Internal Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.