Healthcare Provider Details

I. General information

NPI: 1801842505
Provider Name (Legal Business Name): WILLIAM G CIMINO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 12/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 BEACH RD
FAIRFIELD CT
06824
US

IV. Provider business mailing address

52 BEACH RD STE 207
FAIRFIELD CT
06824-6017
US

V. Phone/Fax

Practice location:
  • Phone: 203-255-7000
  • Fax:
Mailing address:
  • Phone: 203-258-8514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number71499
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number37308
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number37308
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: