Healthcare Provider Details

I. General information

NPI: 1366701229
Provider Name (Legal Business Name): THEADORE A HUFFORD JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2012
Last Update Date: 04/28/2020
Certification Date: 04/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9413 FLATLANDS AVE STE 201
BROOKLYN NY
11236-3726
US

IV. Provider business mailing address

1 BROOKDALE PLZ STE 666
BROOKLYN NY
11212-3139
US

V. Phone/Fax

Practice location:
  • Phone: 718-240-8446
  • Fax: 718-240-5808
Mailing address:
  • Phone: 718-240-7143
  • Fax: 718-240-5808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number35.130486
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number03613822
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number292811
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: