Provider Demographics
NPI:1053554352
Name:TESSIE T PAREDES PHYSICIAN PC
Entity type:Organization
Organization Name:TESSIE T PAREDES PHYSICIAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TESSIE
Authorized Official - Middle Name:TIMTIMAN
Authorized Official - Last Name:PAREDES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-497-8400
Mailing Address - Street 1:318 STANHOPE ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11237-4362
Mailing Address - Country:US
Mailing Address - Phone:718-497-8400
Mailing Address - Fax:718-497-2233
Practice Address - Street 1:318 STANHOPE ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11237-4362
Practice Address - Country:US
Practice Address - Phone:718-497-8400
Practice Address - Fax:718-497-2233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-16
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY178945207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100069071Medicare PIN
NYWES621Medicare PIN