Provider Demographics
NPI:1811280696
Name:ZIMMERMAN, EDWARD ROBERT
Entity type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:ROBERT
Last Name:ZIMMERMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1412 STEPHEN WAY
Mailing Address - Street 2:1412 STEPHEN WAY
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18966-4352
Mailing Address - Country:US
Mailing Address - Phone:215-357-2807
Mailing Address - Fax:
Practice Address - Street 1:1412 STEPHEN WAY
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18966-4352
Practice Address - Country:US
Practice Address - Phone:215-357-2807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-26
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health