Provider Demographics
NPI:1336164821
Name:CIMMET, GERALD (PHD)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:
Last Name:CIMMET
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7237 HOLLYWOOD RD
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19034-1236
Mailing Address - Country:US
Mailing Address - Phone:215-540-9323
Mailing Address - Fax:215-646-4132
Practice Address - Street 1:7237 HOLLYWOOD RD
Practice Address - Street 2:SUITE 2
Practice Address - City:FORT WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:19034-1236
Practice Address - Country:US
Practice Address - Phone:215-540-9323
Practice Address - Fax:215-646-4132
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS004417L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAR07039Medicare UPIN