MEDICARE: DR. MOLLY E ZIMMERMAN PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103G00000X	Clinical Neuropsychologist	017167	NY

General Provider Information

NPI Number	:	1588844757
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MOLLY E ZIMMERMAN PH.D.

Provider Business Mailing Address
First Line	:	615 FORT WASHINGTON AVE
Second Line	:	APT. 3D
City	:	NEW YORK
State	:	NY
Zip	:	10040-3954
Country	:	US
Telephone Number	:	347-604-0414
Fax Number	:

Provider Business Practice Location Address
First Line	:	615 FORT WASHINGTON AVE
Second Line	:	APT. 3D
City	:	NEW YORK
State	:	NY
Zip	:	10040-3954
Country	:	US
Telephone Number	:	347-604-0414
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/05/2007
Last Update Date	:	11/05/2007

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