Provider Demographics
NPI:1912180431
Name:ZIMMERMAN, JAY A (DMD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:A
Last Name:ZIMMERMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 MAPLE ST
Mailing Address - Street 2:SUITE 305
Mailing Address - City:SUMMIT
Mailing Address - State:NJ
Mailing Address - Zip Code:07901-2571
Mailing Address - Country:US
Mailing Address - Phone:908-273-3535
Mailing Address - Fax:908-273-2493
Practice Address - Street 1:47 MAPLE ST
Practice Address - Street 2:SUITE 305
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-2571
Practice Address - Country:US
Practice Address - Phone:908-273-3535
Practice Address - Fax:908-273-2493
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-06
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist