Provider Demographics
NPI:1922736628
Name:CIMINO, JOELLE MARIA
Entity type:Individual
Prefix:
First Name:JOELLE
Middle Name:MARIA
Last Name:CIMINO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:299 HIDDEN ACRES PATH
Mailing Address - Street 2:
Mailing Address - City:WADING RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:11792-2223
Mailing Address - Country:US
Mailing Address - Phone:631-307-8360
Mailing Address - Fax:
Practice Address - Street 1:299 HIDDEN ACRES PATH
Practice Address - Street 2:
Practice Address - City:WADING RIVER
Practice Address - State:NY
Practice Address - Zip Code:11792-2223
Practice Address - Country:US
Practice Address - Phone:631-307-8360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-10
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY261QD1600X
174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities