Healthcare Provider Details

I. General information

NPI: 1982043360
Provider Name (Legal Business Name): CHRISTOPHER JOSEPH CIMINO APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2013
Last Update Date: 06/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 WILLARD AVE
NEWINGTON CT
06111-2631
US

IV. Provider business mailing address

555 WILLARD AVE
NEWINGTON CT
06111-2631
US

V. Phone/Fax

Practice location:
  • Phone: 860-667-6800
  • Fax: 860-667-6872
Mailing address:
  • Phone: 860-667-6800
  • Fax: 860-667-6872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number005289
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: