MEDICARE: THEADORE A HUFFORD JR. MD

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	208600000X	Surgery Physician	036138222	IL
2	208600000X	Surgery Physician	35.130486	OH
3	208600000X	Surgery Physician	292811	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	292811	OTHER	NY	LICENSE

General Provider Information

NPI Number	:	1366701229
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THEADORE A HUFFORD JR. MD

Provider Business Mailing Address
First Line	:	1 BROOKDALE PLZ STE 666
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11212-3139
Country	:	US
Telephone Number	:	718-240-7143
Fax Number	:	718-240-5808

Provider Business Practice Location Address
First Line	:	9413 FLATLANDS AVE STE 201
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11236-3726
Country	:	US
Telephone Number	:	718-240-8446
Fax Number	:	718-240-5808

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/14/2012
Last Update Date	:	02/20/2026

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