Provider Demographics
NPI:1811154834
Name:NICHOLAS C TUMMINELLO DPM PC
Entity type:Organization
Organization Name:NICHOLAS C TUMMINELLO DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:TUMMINELLO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:516-619-3338
Mailing Address - Street 1:263 BROADWAY
Mailing Address - Street 2:SUITE 1B LOWER LEVEL
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-3243
Mailing Address - Country:US
Mailing Address - Phone:516-619-3338
Mailing Address - Fax:516-619-0202
Practice Address - Street 1:263 BROADWAY
Practice Address - Street 2:SUITE 1B LOWER LEVEL
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563-3243
Practice Address - Country:US
Practice Address - Phone:516-619-3338
Practice Address - Fax:516-619-0202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-19
Last Update Date:2015-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004919213ES0000X, 213EP1101X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports MedicineGroup - Multi-Specialty
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1811154834Medicare NSC