Healthcare Provider Details

I. General information

NPI: 1255651287
Provider Name (Legal Business Name): ANTHONY THOMAS CIMMINO D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2010
Last Update Date: 06/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 5TH AVE SUITE 1804
NEW YORK NY
10111-0100
US

IV. Provider business mailing address

630 5TH AVE SUITE 1804
NEW YORK NY
10111-0100
US

V. Phone/Fax

Practice location:
  • Phone: 212-541-6776
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number026863
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: