Healthcare Provider Details

I. General information

NPI: 1962590752
Provider Name (Legal Business Name): DONALD ZIMMERMAN DDS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1075 CENTRAL AVE
CLARK NJ
07066-1113
US

IV. Provider business mailing address

1075 CENTRAL AVE
CLARK NJ
07066-1113
US

V. Phone/Fax

Practice location:
  • Phone: 732-574-1660
  • Fax: 732-574-1660
Mailing address:
  • Phone: 732-574-1660
  • Fax: 732-574-1660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number7777
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. DONALD I ZIMMERMAN
Title or Position: PRESIDENT
Credential: DDS
Phone: 732-574-1660