Provider Demographics
NPI:1073672762
Name:LENOX, THEODORE HENRY III (MD)
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:HENRY
Last Name:LENOX
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1901 FIRST AVENUE
Mailing Address - Street 2:RM 7B-1
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029
Mailing Address - Country:US
Mailing Address - Phone:212-423-7247
Mailing Address - Fax:212-423-7417
Practice Address - Street 1:1901 FIRST AVENUE
Practice Address - Street 2:RM 7B-1
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029
Practice Address - Country:US
Practice Address - Phone:212-423-7247
Practice Address - Fax:212-423-7417
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY141264207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00734143Medicaid
NYE44638Medicare UPIN
NY25F37Medicare ID - Type Unspecified