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Organization
TD ADVANCED MEDICAL PC
Active
Organization
TD ADVANCED MEDICAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LESLIE THEODORE (PRESIDENT)
(718) 740-4984
Entity
Organization
Contact information
Practice address
11054 SPRINGFIELD BLVD, QUEENS VILLAGE, NY 11429-2521
(718) 740-4984
Mailing address
683 HALF HOLLOW RD, DIX HILLS, NY 11746-6232
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Enumeration date
02/05/2010
Last updated
02/05/2010
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