Provider Demographics
NPI:1134133218
Name:CIMPONERIU, DAN ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:DAN
Middle Name:ROBERT
Last Name:CIMPONERIU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2325 31ST ST STE 500
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11105-2299
Mailing Address - Country:US
Mailing Address - Phone:718-626-2337
Mailing Address - Fax:718-626-7655
Practice Address - Street 1:2325 31ST ST STE 500
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11105-2299
Practice Address - Country:US
Practice Address - Phone:718-626-2337
Practice Address - Fax:718-626-7655
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY183504207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01366985Medicaid
NYF26530Medicare UPIN
NY01366985Medicaid