Healthcare Provider Details

I. General information

NPI: 1811154834
Provider Name (Legal Business Name): NICHOLAS C TUMMINELLO DPM PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2008
Last Update Date: 09/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 BROADWAY SUITE 1B LOWER LEVEL
LYNBROOK NY
11563-3243
US

IV. Provider business mailing address

263 BROADWAY SUITE 1B LOWER LEVEL
LYNBROOK NY
11563-3243
US

V. Phone/Fax

Practice location:
  • Phone: 516-619-3338
  • Fax: 516-619-0202
Mailing address:
  • Phone: 516-619-3338
  • Fax: 516-619-0202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberN004919
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License NumberN004919
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberN004919
License Number StateNY

VIII. Authorized Official

Name: DR. NICHOLAS CHARLES TUMMINELLO
Title or Position: PRESIDENT
Credential: D.P.M.
Phone: 516-619-3338