Provider Demographics
NPI:1467433912
Name:ZIMMERMAN, BARRY LEWIS (DO)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:LEWIS
Last Name:ZIMMERMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 BEY LEA RD
Mailing Address - Street 2:BLDG C-103
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-2900
Mailing Address - Country:US
Mailing Address - Phone:732-367-8280
Mailing Address - Fax:732-367-1529
Practice Address - Street 1:40 BEY LEA RD
Practice Address - Street 2:BLDG C SUITE 103
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-2900
Practice Address - Country:US
Practice Address - Phone:732-367-8280
Practice Address - Fax:732-367-1529
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB046073002084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0601004Medicaid
NJ0601004Medicaid
NJ196289BUCMedicare ID - Type UnspecifiedINDIVIDUAL MCR ID