Provider Demographics
NPI:1609022995
Name:MARC CIMMINO DO PC
Entity Type:Organization
Organization Name:MARC CIMMINO DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:C
Authorized Official - Last Name:CIMMINO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:631-969-8700
Mailing Address - Street 1:40 BAY SHORE AVE
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-7929
Mailing Address - Country:US
Mailing Address - Phone:631-969-8700
Mailing Address - Fax:631-969-8703
Practice Address - Street 1:40 BAY SHORE AVE
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-7929
Practice Address - Country:US
Practice Address - Phone:631-969-8700
Practice Address - Fax:631-969-8703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-18
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY172519207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty