Provider Demographics
NPI:1144242355
Name:ZIMMERMAN, JILL ROBIN (MD)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:ROBIN
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:384 N WOODLAND ST
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-2027
Mailing Address - Country:US
Mailing Address - Phone:201-567-1466
Mailing Address - Fax:201-567-1466
Practice Address - Street 1:20 FRANKLIN TPKE
Practice Address - Street 2:
Practice Address - City:WALDWICK
Practice Address - State:NJ
Practice Address - Zip Code:07463-1749
Practice Address - Country:US
Practice Address - Phone:201-445-8822
Practice Address - Fax:201-447-7058
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA077683002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ123626A4HMedicare PIN
PAH02691Medicare UPIN
PA083462Medicare ID - Type Unspecified