Provider Demographics
NPI:1124171806
Name:CIMENT, ETHAN JOSEPH (DPM)
Entity type:Individual
Prefix:DR
First Name:ETHAN
Middle Name:JOSEPH
Last Name:CIMENT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 W 20TH ST
Mailing Address - Street 2:SUITE 308
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-3706
Mailing Address - Country:US
Mailing Address - Phone:646-929-4149
Mailing Address - Fax:347-577-9457
Practice Address - Street 1:37 W 20TH ST
Practice Address - Street 2:SUITE 308
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-3706
Practice Address - Country:US
Practice Address - Phone:646-929-4149
Practice Address - Fax:347-577-9457
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005936213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV00820Medicare UPIN
NYPJ3581Medicare ID - Type Unspecified