Healthcare Provider Details

I. General information

NPI: 1366622920
Provider Name (Legal Business Name): ANGELO M CIMINIELLO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2007
Last Update Date: 11/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 WHITE ST
DANBURY CT
06810-6814
US

IV. Provider business mailing address

226 WHITE ST
DANBURY CT
06810-6814
US

V. Phone/Fax

Practice location:
  • Phone: 203-797-1500
  • Fax: 203-791-0495
Mailing address:
  • Phone: 203-797-1500
  • Fax: 203-791-0495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number047267
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number047267
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: