Basic Information
| Provider Information | |||||||||
| NPI: | 1760667968 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CIMERBERG | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | W | ||||||||
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| Credential: | D.O | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1395 NW 167TH ST | ||||||||
| Address2: | |||||||||
| City: | MIAMI GARDENS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331695710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9543798994 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6037 KIMBERLY BLVD | ||||||||
| Address2: | |||||||||
| City: | NORTH LAUDERDALE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330682811 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9543798994 | ||||||||
| FaxNumber: | 9549772711 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/07/2008 | ||||||||
| LastUpdateDate: | 04/21/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QA0505X | OS5466 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine | Adult Medicine |
ID Information
| ID | Type | State | Issuer | Description | 5296298 | 01 | FL | AETNA PROVIDER NUMBER | OTHER | 80084 | 01 | FL | BLUECROSS BLUE SHEILD | OTHER |