Provider Demographics
NPI:1710940374
Name:ARAMBULO, TEODORICO (MD)
Entity Type:Individual
Prefix:
First Name:TEODORICO
Middle Name:
Last Name:ARAMBULO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:80 MARCUS DR
Mailing Address - Street 2:PROVIDER ENROLLMENT
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-4230
Mailing Address - Country:US
Mailing Address - Phone:631-391-7797
Mailing Address - Fax:631-454-4163
Practice Address - Street 1:14601 45TH AVE
Practice Address - Street 2:RM 406
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355
Practice Address - Country:US
Practice Address - Phone:718-670-5464
Practice Address - Fax:718-670-4569
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY126401208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00250844Medicaid
NY00250844Medicaid
E10312Medicare UPIN