1447254909 NPI number — MR. STEPHEN I. ZIMMERMAN P.T., D.P.T., PH.D.

Table of content: MR. STEPHEN I. ZIMMERMAN P.T., D.P.T., PH.D. (NPI 1447254909)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447254909 NPI number — MR. STEPHEN I. ZIMMERMAN P.T., D.P.T., PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZIMMERMAN
Provider First Name:
STEPHEN
Provider Middle Name:
I.
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
P.T., D.P.T., PH.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ZIMMERMAN
Provider Other First Name:
STEPHEN
Provider Other Middle Name:
I.
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
P.T., D.P.T., PH.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1447254909
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/04/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2421 GRAND AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALDWIN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11510-3219
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-377-7964
Provider Business Mailing Address Fax Number:
516-377-7760

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2421 GRAND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BALDWIN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11510-3219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-377-7964
Provider Business Practice Location Address Fax Number:
516-377-7760
Provider Enumeration Date:
06/11/2005

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: 2251E1300X , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: 003994-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 145529P . This is a "HIP PROVIDER #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 46295 . This is a "VYTRA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 6698763 . This is a "GHI PROVIDER #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: QM8451 . This is a "EMPIRE BC/BS PROV. #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00336567 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0731899 . This is a "CIGNA PROVIDER #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 51201 . This is a "CIGNA/ORTHONET PROV. #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 259759 . This is a "UNITED HEALTHCARE PROV. #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: AZ00575 . This is a "MDNY PROVIDER #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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