Provider Demographics
NPI:1366440133
Name:CIMMINO, CHRISTOPHER JOHN (DO)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:JOHN
Last Name:CIMMINO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8340 WOODHAVEN BLVD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11385-7824
Mailing Address - Country:US
Mailing Address - Phone:718-441-4444
Mailing Address - Fax:718-849-7854
Practice Address - Street 1:83-40 WOODHAVEN BLVD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:NY
Practice Address - Zip Code:11385-7824
Practice Address - Country:US
Practice Address - Phone:718-441-4444
Practice Address - Fax:718-849-7854
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY134874204C00000X, 207Q00000X, 208100000X, 2083S0010X, 208VP0000X, 209800000X
NY137874208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2083S0010XAllopathic & Osteopathic PhysiciansPreventive MedicineSports Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No209800000XAllopathic & Osteopathic PhysiciansLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY007 998 80Medicaid
NY07267Medicare PIN
NY05A731Medicare ID - Type UnspecifiedBC/BS MEDICARE #
NY07052Medicare ID - Type UnspecifiedGHI MEDICARE IDTF #
NY007 998 80Medicaid
NY05137Medicare ID - Type UnspecifiedGHI MEDICARE #