Provider Demographics
NPI:1992722623
Name:CENNIMO, DAVID JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JOHN
Last Name:CENNIMO
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 1:278 LONGVIEW RD
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-8282
Mailing Address - Country:US
Mailing Address - Phone:908-964-0468
Mailing Address - Fax:908-851-2595
Practice Address - Street 1:90 BERGEN ST
Practice Address - Street 2:SUITE 4400
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-2425
Practice Address - Country:US
Practice Address - Phone:973-312-4523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA07676400207R00000X, 207RI0200X, 208000000X, 2080P0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics
Not Answered2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases