Provider Demographics
NPI:1528036217
Name:ZIMMERMAN, JOHN M (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:ZIMMERMAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:20 GRAND ST
Mailing Address - Street 2:FL 3
Mailing Address - City:WARWICK
Mailing Address - State:NY
Mailing Address - Zip Code:10990-1035
Mailing Address - Country:US
Mailing Address - Phone:845-368-8800
Mailing Address - Fax:845-987-5979
Practice Address - Street 1:20 PROSPECT AVE
Practice Address - Street 2:STE 701
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1997
Practice Address - Country:US
Practice Address - Phone:201-996-2997
Practice Address - Fax:201-996-2571
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2020-04-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJMA05047300207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ060066695OtherRR MDCR #
NJ2140120OtherAETNA HMO #
NJ614P31OtherEMPIRE BCBS (255 LAFAYET)
NJ0162507Medicaid
NJ05D742OtherEMPIRE BCBS (30 PROSPECT)
NJ2K7886OtherHEALTHNET #
NJ8213937OtherGHI (PPO) #
NJBS503OtherOXFORD #
NJ05D743OtherEMPIRE BCBS (20 PROSPECT)
NJ4346389OtherAETNA PPO #
NJ4346389OtherAETNA PPO #
NY637Q0YBXT1Medicare PIN
NJ05D742OtherEMPIRE BCBS (30 PROSPECT)
NY637Q01Medicare PIN