Healthcare Provider Details

I. General information

NPI: 1578552105
Provider Name (Legal Business Name): CALOGERO C. TUMMINELLO, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2005
Last Update Date: 02/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7817 METROPOLITAN AVE
MIDDLE VILLAGE NY
11379-2928
US

IV. Provider business mailing address

7817 METROPOLITAN AVE
MIDDLE VILLAGE NY
11379-2928
US

V. Phone/Fax

Practice location:
  • Phone: 718-497-1399
  • Fax: 718-497-1451
Mailing address:
  • Phone: 718-497-1399
  • Fax: 718-497-1451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number185-153
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number185-153
License Number StateNY

VIII. Authorized Official

Name: DR. CALOGERO C TUMMINELLO
Title or Position: CEO/PRESIDENT
Credential: M.D.
Phone: 718-497-1399