Provider Demographics
NPI:1770759839
Name:DAN R CIMPONERIU PHYSICIAN, PC
Entity type:Organization
Organization Name:DAN R CIMPONERIU PHYSICIAN, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LETY
Authorized Official - Middle Name:
Authorized Official - Last Name:COTTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-416-4389
Mailing Address - Street 1:8545 ELIOT AVE
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-2750
Mailing Address - Country:US
Mailing Address - Phone:718-416-4389
Mailing Address - Fax:718-416-3652
Practice Address - Street 1:8545 ELIOT AVE
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-2750
Practice Address - Country:US
Practice Address - Phone:718-416-4389
Practice Address - Fax:718-416-3652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-07
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY123456Medicare PIN