Healthcare Provider Details

I. General information

NPI: 1114042942
Provider Name (Legal Business Name): GHEORGHE CIUMPAVU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 04/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 WATERS PL
BRONX NY
10461-2723
US

IV. Provider business mailing address

515 W. STREET
NEW YORK NY
10019
US

V. Phone/Fax

Practice location:
  • Phone: 718-931-0600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number242153
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: