1154539492 NPI number — DR. THOMAS ROBERT ZIMMERMAN JR. M.D.

Table of content: DR. THOMAS ROBERT ZIMMERMAN JR. M.D. (NPI 1154539492)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154539492 NPI number — DR. THOMAS ROBERT ZIMMERMAN JR. M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZIMMERMAN
Provider First Name:
THOMAS
Provider Middle Name:
ROBERT
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154539492
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
230 MENDHAM RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BERNARDSVILLE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07924-1626
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
908-766-0750
Provider Business Mailing Address Fax Number:
908-766-4870

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
80 MORRISTOWN RD
Provider Second Line Business Practice Location Address:
SUITE 302
Provider Business Practice Location Address City Name:
BERNARDSVILLE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07924-2313
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-766-0750
Provider Business Practice Location Address Fax Number:
908-766-4870
Provider Enumeration Date:
05/18/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RG0300X , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 2084N0400X , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 53F98 . This is a "NJ-BLUE SHIELD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 58114386B . This is a "WELFARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1221906 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".