Provider Demographics
NPI:1932160173
Name:ZIMMER, MARC A (PH D)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:A
Last Name:ZIMMER
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 SUNRISE PLAZA
Mailing Address - Street 2:SUITE #202
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580
Mailing Address - Country:US
Mailing Address - Phone:516-825-5005
Mailing Address - Fax:516-825-5778
Practice Address - Street 1:5 SUNRISE PLAZA
Practice Address - Street 2:SUITE #202
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580
Practice Address - Country:US
Practice Address - Phone:516-825-5005
Practice Address - Fax:516-825-5778
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR17497103T00000X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No103T00000XBehavioral Health & Social Service ProvidersPsychologist