Provider Demographics
NPI:1083685747
Name:ZIMMERMANN, SUSANNE W (MD)
Entity Type:Individual
Prefix:
First Name:SUSANNE
Middle Name:W
Last Name:ZIMMERMANN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2-12 CORBETT WAY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:EATONTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-4251
Mailing Address - Country:US
Mailing Address - Phone:732-263-7965
Mailing Address - Fax:732-263-7962
Practice Address - Street 1:2-12 CORBETT WAY
Practice Address - Street 2:SUITE 102
Practice Address - City:EATONTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07724-4251
Practice Address - Country:US
Practice Address - Phone:732-263-7965
Practice Address - Fax:732-263-7962
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA56118207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ132643CMVMedicare PIN
NJF39794Medicare UPIN