Provider Demographics
NPI:1427385707
Name:CIMINELLI, ANTONETTA (M A CCC-SLP, TSHH)
Entity Type:Individual
Prefix:MRS
First Name:ANTONETTA
Middle Name:
Last Name:CIMINELLI
Suffix:
Gender:F
Credentials:M A CCC-SLP, TSHH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 KNOLLWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CARLE PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:11514-1408
Mailing Address - Country:US
Mailing Address - Phone:516-414-8107
Mailing Address - Fax:
Practice Address - Street 1:1880 DUTCH BROADWAY
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-4246
Practice Address - Country:US
Practice Address - Phone:516-326-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-07
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013141235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist