Provider Demographics
NPI:1811048549
Name:STEPHEN I. ZIMMERMAN, PH.D., P.T., P.C.
Entity type:Organization
Organization Name:STEPHEN I. ZIMMERMAN, PH.D., P.T., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:I
Authorized Official - Last Name:ZIMMERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, PHD
Authorized Official - Phone:516-377-7964
Mailing Address - Street 1:2421 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-3219
Mailing Address - Country:US
Mailing Address - Phone:516-377-7964
Mailing Address - Fax:516-377-7760
Practice Address - Street 1:2421 GRAND AVE
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-3219
Practice Address - Country:US
Practice Address - Phone:516-377-7964
Practice Address - Fax:516-377-7760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003994-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00336567Medicaid
NY46295OtherVYTRA PROVIDER #
NY5C7329OtherHEALTHNET PROVIDER #
NY145529POtherHIP PROVIDER #
NYAZ00575OtherMDNY PROVIDER #
NY0731899OtherCIGNA PROVIDER #
NY259759OtherUNITED HEALTHCARE PROV. #
NY5120LOtherCIGNA ORTHONET PROVIDER #
NY6698763OtherGHI PROVIDER #
NYQM8451OtherEMPIRE BLUE CROSS BLUE SH
NY6698763OtherGHI PROVIDER #