Provider Demographics
NPI:1316126485
Name:CZIMBER, VIRGINIA T (NP)
Entity type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:T
Last Name:CZIMBER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 RADIO AVE
Mailing Address - Street 2:
Mailing Address - City:MILLER PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:11764-3125
Mailing Address - Country:US
Mailing Address - Phone:631-211-8911
Mailing Address - Fax:631-821-8912
Practice Address - Street 1:43 RADIO AVE
Practice Address - Street 2:
Practice Address - City:MILLER PLACE
Practice Address - State:NY
Practice Address - Zip Code:11764-3125
Practice Address - Country:US
Practice Address - Phone:631-821-8911
Practice Address - Fax:631-821-8912
Is Sole Proprietor?:No
Enumeration Date:2007-10-25
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF353679-01363LF0000X
NC5003377363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1316126485Medicaid
NC1316126485Medicaid
NCNC3551CMedicare UPIN