Organization Active NPI

Bayshore Medical Care, P.C.

  • Family Medicine Physician
  • Bay Shore, NY
National Provider Identifier
1457531972
Registry record updated Jun 16, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
172519 Issued in NY
Legal business name
BAYSHORE MEDICAL CARE, P.C.
Practice address
40 Bay Shore Ave
Bay Shore, NY 11706-7929
Phone
(631) 969-8700
Fax
(631) 969-8703
NPI assigned
Nov 13, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Marc Cimmino, D.O.
Title
Owner/ Physician
Phone
(631) 969-8700

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X 172519 NY Primary

Addresses

Primary practice location

40 Bay Shore Ave
Bay Shore, NY 11706-7929

Mailing address

40 Bay Shore Ave
Bay Shore, NY 11706-7929
Phone (631) 969-8700

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1194912000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1434412800000",
    "number": "1457531972",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40 BAY SHORE AVE",
            "city": "BAY SHORE",
            "state": "NY",
            "postal_code": "117067929",
            "telephone_number": "631-969-8700",
            "fax_number": "631-969-8703"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40 BAY SHORE AVE",
            "city": "BAY SHORE",
            "state": "NY",
            "postal_code": "117067929",
            "telephone_number": "631-969-8700",
            "fax_number": "631-969-8703"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAYSHORE MEDICAL CARE, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-13",
        "last_updated": "2015-06-16",
        "status": "A",
        "authorized_official_last_name": "CIMMINO",
        "authorized_official_first_name": "MARC",
        "authorized_official_title_or_position": "OWNER/ PHYSICIAN",
        "authorized_official_telephone_number": "631-969-8700",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "172519",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bay Shore, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.