Provider Demographics
NPI:1245242650
Name:PAREDES, TESSIE TIMTIMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:TESSIE
Middle Name:TIMTIMAN
Last Name:PAREDES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158-17 GOETHALS AVENUE
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432
Mailing Address - Country:US
Mailing Address - Phone:718-969-3160
Mailing Address - Fax:
Practice Address - Street 1:318 STANHOPE ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11237
Practice Address - Country:US
Practice Address - Phone:718-497-8400
Practice Address - Fax:718-497-2233
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY178945207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01134505Medicaid
NY23F501Medicare ID - Type Unspecified
NY01134505Medicaid