Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 172519 | NY |
N | 204C00000X | Sports Medicine Doctor | 1725191 | NY |
NPI | 1669578159 |
---|---|
Provider Name | Dr. Marc Cimmino |
First Address | East Islip, NY 11730-0318 |
Second Address | Bay Shore, NY 11706-7929 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E17199 | (02) | NY |