Provider Demographics
NPI:1528272648
Name:CIMINIELLO, MICHAEL EMANUEL (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:EMANUEL
Last Name:CIMINIELLO
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 1:64 COMMERCE AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-4455
Mailing Address - Country:US
Mailing Address - Phone:631-547-8770
Mailing Address - Fax:631-574-8773
Practice Address - Street 1:64 COMMERCE AVE
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-4455
Practice Address - Country:US
Practice Address - Phone:631-547-8770
Practice Address - Fax:631-574-8773
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD430604207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400028948Medicare PIN