Provider Demographics
NPI:1669656021
Name:MITCHELL T ZIMMEL
Entity Type:Organization
Organization Name:MITCHELL T ZIMMEL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIMMEL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:732-224-0800
Mailing Address - Street 1:180 WHITE RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:LITTLE SILVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07739-1166
Mailing Address - Country:US
Mailing Address - Phone:732-224-0800
Mailing Address - Fax:732-224-0918
Practice Address - Street 1:180 WHITE RD
Practice Address - Street 2:SUITE 105
Practice Address - City:LITTLE SILVER
Practice Address - State:NJ
Practice Address - Zip Code:07739-1166
Practice Address - Country:US
Practice Address - Phone:732-224-0800
Practice Address - Fax:732-224-0918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-20
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0944340001Medicare NSC
T77546Medicare UPIN
NJ098094Medicare PIN