1437194966 NPI number — DEBRA CAROL ZIMRING M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437194966 NPI number — DEBRA CAROL ZIMRING M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

ZIMRING

Provider First Name:

DEBRA

Provider Middle Name:

CAROL

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

F

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

SANDERS

Provider Other First Name:

DEBRA

Provider Other Middle Name:

C

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

M.D.

Provider Other Last Name Type Code:

1

NPI Number:

1437194966

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

06/02/2021

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

711 TROY SCHENECTADY RD STE 201

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

LATHAM

Provider Business Mailing Address State Name:

NY

Provider Business Mailing Address Postal Code:

12110-2461

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

518-782-3742

Provider Business Mailing Address Fax Number:

518-782-3799

Provider First Line Business Practice Location Address:

1240 NEW SCOTLAND RD STE 203

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

SLINGERLANDS

Provider Business Practice Location Address State Name:

NY

Provider Business Practice Location Address Postal Code:

12159-9222

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

518-439-2460

Provider Business Practice Location Address Fax Number:

518-439-3025

Provider Enumeration Date:

06/18/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 2083A0300X , with the licence number:  208084 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207Q00000X , with the licence number: 208084 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 000494029004 . This is a "BSNENY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 080123000067 . This is a "FIDELIS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 01995179 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
• Identifier: 10034687 . This is a "CDPHP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 7838049 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 209060 . This is a "SENIOR WHOLE HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 4159331 . This is a "MVP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 119666 . This is a "GHI-HMO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 5715P1 . This is a "EMPIRE BC" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".