Provider Demographics
NPI:1972799161
Name:ZIMILEVICH, BELLA (MD)
Entity Type:Individual
Prefix:
First Name:BELLA
Middle Name:
Last Name:ZIMILEVICH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6301 MILL LN
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-5512
Mailing Address - Country:US
Mailing Address - Phone:718-942-4600
Mailing Address - Fax:
Practice Address - Street 1:6301 MILL LN
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-5512
Practice Address - Country:US
Practice Address - Phone:718-942-4600
Practice Address - Fax:718-942-4605
Is Sole Proprietor?:No
Enumeration Date:2007-09-20
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT045858207RG0300X
NY251120207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY251120OtherLICENSE
CT045858OtherLICENSE
CT380000195Medicare PIN
NY251120OtherLICENSE