Healthcare Provider Details

I. General information

NPI: 1750737359
Provider Name (Legal Business Name): REBEKAH ZIMMERMAN PH.D., FACMG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2016
Last Update Date: 05/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 ALLEN RD SUITE 300
BASKING RIDGE NJ
07920-2976
US

IV. Provider business mailing address

140 ALLEN RD SUITE 300
BASKING RIDGE NJ
07920-2976
US

V. Phone/Fax

Practice location:
  • Phone: 908-580-1200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207SG0203X
TaxonomyClinical Molecular Genetics Physician
License Number25MS00017600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: