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NPI Code Detail

MEDICARE: DR. CHRISTOPHER JOHN CIMMINO D.O.

MEDICARE: DR. CHRISTOPHER JOHN CIMMINO D.O.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1204C00000XSports Medicine (Neuromusculoskeletal Medicine) Physician134874NY
2207Q00000XFamily Medicine Physician134874NY
3208100000XPhysical Medicine & Rehabilitation Physician134874NY
42083S0010XSports Medicine (Preventive Medicine) Physician134874NY
5208VP0000XPain Medicine Physician134874NY
6208VP0014XInterventional Pain Medicine Physician137874NY
7209800000XLegal Medicine (M.D./D.O.) Physician134874NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1366440133
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHRISTOPHER JOHN CIMMINO D.O.
Provider Business Mailing Address
First Line : 8340 WOODHAVEN BLVD
Second Line :
City : GLENDALE
State : NY
Zip : 11385-7824
Country : US
Telephone Number : 718-441-4444
Fax Number : 718-849-7854
Provider Business Practice Location Address
First Line : 83-40 WOODHAVEN BLVD
Second Line :
City : GLENDALE
State : NY
Zip : 11385-7824
Country : US
Telephone Number : 718-441-4444
Fax Number : 718-849-7854
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/14/2005
Last Update Date : 10/22/2010

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