Provider Demographics
NPI:1316356603
Name:ZIMMERMAN, MATTHEW ADAM (DC)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:ADAM
Last Name:ZIMMERMAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 E 105TH ST APT 6B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-5271
Mailing Address - Country:US
Mailing Address - Phone:732-397-1641
Mailing Address - Fax:
Practice Address - Street 1:280 MADISON AVE RM 810
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-0805
Practice Address - Country:US
Practice Address - Phone:732-397-1641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-12
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012553111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor