MEDICARE: CORNERSTONE MEDICAL CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	ME100976	FL

General Provider Information

NPI Number	:	1326218090
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORNERSTONE MEDICAL CENTER

Provider Business Mailing Address
First Line	:	683 HALF HOLLOW RD
Second Line	:
City	:	DIX HILLS
State	:	NY
Zip	:	11746-6232
Country	:	US
Telephone Number	:	631-960-2544
Fax Number	:	718-613-4754

Provider Business Practice Location Address
First Line	:	1117 ROYAL PALM BEACH BLVD
Second Line	:
City	:	ROYAL PALM BEACH
State	:	FL
Zip	:	33411-1641
Country	:	US
Telephone Number	:	561-422-0037
Fax Number	:	561-422-0115

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. LESLIE D THEODORE
Credential	:	M.D.
Telephone Number	:	561-422-0037

Provider Enumeration Date	:	03/10/2008
Last Update Date	:	03/10/2008

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Directions to “CORNERSTONE MEDICAL CENTER ” Practice Location

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