1366083503 NPI number — LAURA ZIMMERMANN DPT

Table of content: LAURA ZIMMERMANN DPT (NPI 1366083503)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366083503 NPI number — LAURA ZIMMERMANN DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZIMMERMANN
Provider First Name:
LAURA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
F

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:
1366083503
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/30/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
108 SWEDESBORO RD STE 10
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MULLICA HILL
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08062-1800
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-223-8898
Provider Business Mailing Address Fax Number:
856-223-8799

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
108 SWEDESBORO RD STE 10
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MULLICA HILL
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08062-1800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-223-8898
Provider Business Practice Location Address Fax Number:
856-223-8799
Provider Enumeration Date:
09/30/2019

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: 2251P0200X , with the licence number:  40QA01892600 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2251S0007X , with the licence number: 40QA01892600 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2251X0800X , with the licence number: 40QA01892600 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: 40QA01892600 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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