Provider Demographics
NPI:1154490514
Name:TRANDAFIRESCU, THEO
Entity type:Individual
Prefix:
First Name:THEO
Middle Name:
Last Name:TRANDAFIRESCU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13856 78TH DR
Mailing Address - Street 2:
Mailing Address - City:KEW GARDENS HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11367-3238
Mailing Address - Country:US
Mailing Address - Phone:718-465-4000
Mailing Address - Fax:718-776-6823
Practice Address - Street 1:216 -16 UNION TPKE
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11367
Practice Address - Country:US
Practice Address - Phone:718-465-4000
Practice Address - Fax:718-776-6823
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY230548207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty