Provider Demographics
NPI:1093865727
Name:ZIMMERMAN, JAY (MD)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:
Last Name:ZIMMERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:425 GUY PARK AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:AMSTERDAM
Mailing Address - State:NY
Mailing Address - Zip Code:12010-1043
Mailing Address - Country:US
Mailing Address - Phone:518-843-1240
Mailing Address - Fax:518-843-0753
Practice Address - Street 1:425 GUY PARK AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010-1043
Practice Address - Country:US
Practice Address - Phone:518-843-1240
Practice Address - Fax:518-843-0753
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2015-02-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT038217207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTI20464Medicare UPIN