Provider Demographics
NPI:1578552105
Name:CALOGERO C. TUMMINELLO, M.D., P.C.
Entity Type:Organization
Organization Name:CALOGERO C. TUMMINELLO, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CALOGERO
Authorized Official - Middle Name:C
Authorized Official - Last Name:TUMMINELLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-497-1399
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
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CALOGERO C. TUMMINELLO, MD, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-10-17
Last Update Date:2011-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY185-153207R00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01335175Medicaid
NY33D1019073OtherCLIA
NYF00633Medicare UPIN
NY00211Medicare ID - Type UnspecifiedGHI MEDICARE
NY01335175Medicaid