Provider Demographics
NPI:1760003248
Name:NEW YORK INSTITUTE OF TECHNOLOGY
Entity Type:Organization
Organization Name:NEW YORK INSTITUTE OF TECHNOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT DEAN
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:K
Authorized Official - Last Name:ZIMMERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MPA
Authorized Official - Phone:516-320-1466
Mailing Address - Street 1:PO BOX 119
Mailing Address - Street 2:
Mailing Address - City:STATE UNIVERSITY
Mailing Address - State:AR
Mailing Address - Zip Code:72467-0119
Mailing Address - Country:US
Mailing Address - Phone:516-320-1466
Mailing Address - Fax:
Practice Address - Street 1:333B RED WOLF BLVD
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72405-9739
Practice Address - Country:US
Practice Address - Phone:870-972-2054
Practice Address - Fax:870-972-2131
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEW YORK INSTITUTE OF TECHNOLOGY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-05-06
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty