Provider Demographics
NPI:1346239969
Name:TUMMINELLO, CALOGERO (MD)
Entity Type:Individual
Prefix:DR
First Name:CALOGERO
Middle Name:
Last Name:TUMMINELLO
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 1:7817 METROPOLITAN AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLE VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11379-2928
Mailing Address - Country:US
Mailing Address - Phone:718-497-1399
Mailing Address - Fax:718-497-1451
Practice Address - Street 1:7817 METROPOLITAN AVE
Practice Address - Street 2:
Practice Address - City:MIDDLE VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11379-2928
Practice Address - Country:US
Practice Address - Phone:718-497-1399
Practice Address - Fax:718-497-1451
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY185-153207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01335175Medicaid
NY05G162Medicare ID - Type UnspecifiedEMPIRE MEDICARE
NY01335175Medicaid
NY00211Medicare ID - Type UnspecifiedGHI MEDICARE