Provider Demographics
NPI:1023187044
Name:OPTY MEDICAL, P.C.
Entity type:Organization
Organization Name:OPTY MEDICAL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:J
Authorized Official - Last Name:CIMMINO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:718-441-4444
Mailing Address - Street 1:83-40 WOODHAVEN BLVD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11385-7824
Mailing Address - Country:US
Mailing Address - Phone:718-441-4444
Mailing Address - Fax:718-849-7854
Practice Address - Street 1:8340 WOODHAVEN BLVD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:NY
Practice Address - Zip Code:11385-7824
Practice Address - Country:US
Practice Address - Phone:718-441-4444
Practice Address - Fax:718-849-7854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY134874207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Multi-Specialty