Provider Demographics
NPI:1598787798
Name:ZIMMELMAN, STANLEY S (DO)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:S
Last Name:ZIMMELMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3640 YACHT CLUB DR
Mailing Address - Street 2:# 1109
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-3558
Mailing Address - Country:US
Mailing Address - Phone:305-932-1103
Mailing Address - Fax:305-932-1104
Practice Address - Street 1:3640 YACHT CLUB DR
Practice Address - Street 2:# 1109
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-3558
Practice Address - Country:US
Practice Address - Phone:305-932-1103
Practice Address - Fax:305-932-1104
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS63772085R0202X
PAOS8012L2085R0202X
ORDO258962085R0202X
OH0120312084A0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2708793OtherHIGHMARK BLUE SHIELD
PA1619012OtherGATEWAY
MD054047100Medicaid
PA419772OtherUPMC
BZ4762503OtherDEA
PA419772OtherUPMC
PA1619012OtherGATEWAY
PAP01170843Medicare PIN
PA2708793OtherHIGHMARK BLUE SHIELD