Provider Demographics
NPI:1689993982
Name:ZIMMER, GAIL SHARON
Entity Type:Individual
Prefix:MS
First Name:GAIL
Middle Name:SHARON
Last Name:ZIMMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:819 BROADWAY
Mailing Address - Street 2:APARTMENT 1M
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-2643
Mailing Address - Country:US
Mailing Address - Phone:516-457-8607
Mailing Address - Fax:
Practice Address - Street 1:819 BROADWAY
Practice Address - Street 2:APARTMENT 1M
Practice Address - City:WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11598-2643
Practice Address - Country:US
Practice Address - Phone:516-457-8607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-26
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000139-1133N00000X
NY17436133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist