Provider Demographics
NPI:1699852103
Name:CIANCIMINO, ALBERT J (MD)
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:J
Last Name:CIANCIMINO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 COURT ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11231-4335
Mailing Address - Country:US
Mailing Address - Phone:718-855-1543
Mailing Address - Fax:
Practice Address - Street 1:335 COURT ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11231-4335
Practice Address - Country:US
Practice Address - Phone:718-855-1543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY129362207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY321422OtherBLUE CROSS BLUE SHIELD
NY00249692Medicaid
NY0097952OtherGHI
NY0097952OtherGHI
NY321422OtherBLUE CROSS BLUE SHIELD