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General NPI Number Information
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NPI Number | 1326218090
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Entity Type | Organization
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Legal Business Name | CORNERSTONE MEDICAL CENTER
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Dates
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Enumeration Date | 03/10/2008
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Last Update Date | 03/10/2008
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Provider Practice Location Address
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Address Line | 1117 ROYAL PALM BEACH BLVD
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City | ROYAL PALM BEACH
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State | FL
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Zip | 33411-1641
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Country | US
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Telephone | 561-422-0037
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Fax | 561-422-0115
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Provider Business Mailing Address
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Address Line | 683 HALF HOLLOW RD
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City | DIX HILLS
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State | NY
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Zip | 11746-6232
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Country | US
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Telephone | 631-960-2544
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Fax | 718-613-4754
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. LESLIE D THEODORE
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Credential | M.D.
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Telephone | 561-422-0037
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | ME100976
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License Number State | FL
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