Healthcare Provider Details

I. General information

NPI: 1023187044
Provider Name (Legal Business Name): OPTY MEDICAL, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 10/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8340 WOODHAVEN BLVD
GLENDALE NY
11385-7824
US

IV. Provider business mailing address

83-40 WOODHAVEN BLVD
GLENDALE NY
11385-7824
US

V. Phone/Fax

Practice location:
  • Phone: 718-441-4444
  • Fax: 718-849-7854
Mailing address:
  • Phone: 718-441-4444
  • Fax: 718-849-7854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number134874
License Number StateNY

VIII. Authorized Official

Name: DR. CHRISTOPHER J CIMMINO
Title or Position: PRESIDENT
Credential: D.O.
Phone: 718-441-4444