Healthcare Provider Details

I. General information

NPI: 1770759839
Provider Name (Legal Business Name): DAN R CIMPONERIU PHYSICIAN, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2008
Last Update Date: 08/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8545 ELIOT AVE
REGO PARK NY
11374-2750
US

IV. Provider business mailing address

8545 ELIOT AVE
REGO PARK NY
11374-2750
US

V. Phone/Fax

Practice location:
  • Phone: 718-416-4389
  • Fax: 718-416-3652
Mailing address:
  • Phone: 718-416-4389
  • Fax: 718-416-3652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. LETY COTTO
Title or Position: BILLING MANAGER
Credential:
Phone: 718-416-4389