Provider Demographics
NPI:1144339367
Name:ZIMMERMAN, HOWARD MARTIN (MD)
Entity type:Individual
Prefix:
First Name:HOWARD
Middle Name:MARTIN
Last Name:ZIMMERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3003 NEW HYDE PARK RD
Mailing Address - Street 2:SUITE 306
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1214
Mailing Address - Country:US
Mailing Address - Phone:516-352-0022
Mailing Address - Fax:516-352-6807
Practice Address - Street 1:3003 NEW HYDE PARK RD
Practice Address - Street 2:SUITE 306
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1214
Practice Address - Country:US
Practice Address - Phone:516-352-0022
Practice Address - Fax:516-352-6807
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY135094207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY89A581OtherBLUE CROSS
NY57981GMedicare PIN
NY89A581OtherBLUE CROSS
NYCJ2561Medicare PIN
NYWXQRP1Medicare PIN
NY89A58XQRP1Medicare PIN