Provider Demographics
NPI:1629447404
Name:CIMAGLIA, DAWN MARIE
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:MARIE
Last Name:CIMAGLIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:MARIE
Other - Last Name:DETJEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, TSHH
Mailing Address - Street 1:3 MARSHMELLOW DR
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-1018
Mailing Address - Country:US
Mailing Address - Phone:631-368-3165
Mailing Address - Fax:
Practice Address - Street 1:3 MARSHMELLOW DR
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-1018
Practice Address - Country:US
Practice Address - Phone:631-368-3165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-22
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY462148041252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency