Provider Demographics
NPI:1639124399
Name:ZIMMERMAN, STANLEY R (MD)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:R
Last Name:ZIMMERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 STATE ROUTE 27
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-1138
Mailing Address - Country:US
Mailing Address - Phone:732-821-5656
Mailing Address - Fax:732-821-7743
Practice Address - Street 1:2300 STATE ROUTE 27
Practice Address - Street 2:SUITE 1A
Practice Address - City:NORTH BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08902-1138
Practice Address - Country:US
Practice Address - Phone:732-821-5656
Practice Address - Fax:732-821-7743
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA03479900207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1687107Medicaid
NJLP221OtherOXFORD
NJLP221OtherOXFORD
NJ1687107Medicaid