Individual provider Active NPI

Timothy Cullinan, D.C.

  • Chiropractor
  • Oyster Bay, NY
National Provider Identifier
1679632343
Registry record updated Jun 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
X009083-2 Issued in NY
Practice address
72 W Main St
Oyster Bay, NY 11771-2211
Phone
(516) 922-4606
NPI assigned
Dec 8, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 4, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X X009083-2 NY Primary

Addresses

Primary practice location

72 W Main St
Oyster Bay, NY 11771-2211

Mailing address

11 Chester St
Lake Grove, NY 11755-3045
Phone (631) 737-1022

Other identifiers 1

IdentifierTypeStateIssuer
C09083MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120130000505 NY Practitioner - Chiropractic 6608033972 Practice locations: Oyster Bay, NY

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Life Chiropractic College, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

72 W Main St
Oyster Bay, NJ 11771-2211

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
X009083-2NYMDChiropractor
009083NYMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Dr Timothy Cullinan DC PLLC Chiropractor Current Accepting new patients

Locations

72 W Main St
Oyster Bay, NY 11771
Phone (516) 922-4606

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1165536000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717459200000",
    "number": "1679632343",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 CHESTER ST",
            "city": "LAKE GROVE",
            "state": "NY",
            "postal_code": "117553045",
            "telephone_number": "631-737-1022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "72 W MAIN ST",
            "city": "OYSTER BAY",
            "state": "NY",
            "postal_code": "117712211",
            "telephone_number": "516-922-4606"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CULLINAN",
        "first_name": "TIMOTHY",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-08",
        "last_updated": "2024-06-04",
        "certification_date": "2024-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NY",
            "license": "X009083-2",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "C09083",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Oyster Bay, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.