Provider Demographics
NPI:1316001852
Name:CYPRESS MEDICAL PC
Entity Type:Organization
Organization Name:CYPRESS MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT MD
Authorized Official - Prefix:DR
Authorized Official - First Name:SMARANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:COCIOBA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-497-8117
Mailing Address - Street 1:16-84 WOODBINE ST
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385
Mailing Address - Country:US
Mailing Address - Phone:718-497-8117
Mailing Address - Fax:718-497-3208
Practice Address - Street 1:1684 WOODBINE ST
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385
Practice Address - Country:US
Practice Address - Phone:718-497-8117
Practice Address - Fax:718-497-3208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY164309208100000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00930323Medicaid
NY00930323Medicaid
B16892Medicare UPIN