Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | 134874 | NY |
Y | 207Q00000X | Family Doctor | 134874 | NY |
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 134874 | NY |
NPI | 1366440133 |
---|---|
Provider Name | Dr. Christopher John Cimmino |
First Address | Glendale, NY 11385-7824 |
Second Address | Glendale, NY 11385-7824 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2005 |
Last Update Date | 22/10/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
007 998 80 | (05) | NY |
E78198 | (02) | NY |