Provider Demographics
NPI:1376579060
Name:ZIMMERLING, INNA (OD)
Entity Type:Individual
Prefix:
First Name:INNA
Middle Name:
Last Name:ZIMMERLING
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:538 UNDERCLIFF AVE
Mailing Address - Street 2:UNIT B
Mailing Address - City:EDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:07020-1310
Mailing Address - Country:US
Mailing Address - Phone:201-218-4485
Mailing Address - Fax:
Practice Address - Street 1:16 E PROSPECT ST
Practice Address - Street 2:
Practice Address - City:WALDWICK
Practice Address - State:NJ
Practice Address - Zip Code:07463-2008
Practice Address - Country:US
Practice Address - Phone:902-290-6933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-24
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1245152W00000X
NY006841152W00000X
NYTUV00684100152W00000X
NJ27OA00584700152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U80982Medicare UPIN
NYC431D1Medicare Oscar/Certification