Provider Demographics
NPI:1376831545
Name:TSIMERMAN, ALLA (DO)
Entity Type:Individual
Prefix:DR
First Name:ALLA
Middle Name:
Last Name:TSIMERMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 OLD TOWN RD
Mailing Address - Street 2:BASEMENT
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-4212
Mailing Address - Country:US
Mailing Address - Phone:718-407-2914
Mailing Address - Fax:
Practice Address - Street 1:88 OLD TOWN RD
Practice Address - Street 2:BASEMENT
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-4212
Practice Address - Country:US
Practice Address - Phone:718-407-2914
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-21
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY274167207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03923282Medicaid