Provider Demographics
NPI:1801820782
Name:ZIMMER, ROBERT ANDREW (DPM)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ANDREW
Last Name:ZIMMER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 CENTRAL AVE
Mailing Address - Street 2:P.O.BOX 568
Mailing Address - City:DUNKIRK
Mailing Address - State:NY
Mailing Address - Zip Code:14048-2539
Mailing Address - Country:US
Mailing Address - Phone:716-366-6393
Mailing Address - Fax:716-366-6394
Practice Address - Street 1:614 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:DUNKIRK
Practice Address - State:NY
Practice Address - Zip Code:14048-2539
Practice Address - Country:US
Practice Address - Phone:716-366-6393
Practice Address - Fax:716-366-6394
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNOO3623-1213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01158492Medicaid
NY50596AMedicare ID - Type Unspecified
NY01158492Medicaid
NY1194140001Medicare NSC