Healthcare Provider Details

I. General information

NPI: 1528036217
Provider Name (Legal Business Name): JOHN M ZIMMERMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 04/28/2020
Certification Date: 04/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 PROSPECT AVE STE 701
HACKENSACK NJ
07601-1997
US

IV. Provider business mailing address

20 GRAND ST FL 3
WARWICK NY
10990-1035
US

V. Phone/Fax

Practice location:
  • Phone: 201-996-2997
  • Fax: 201-996-2571
Mailing address:
  • Phone: 845-368-8800
  • Fax: 845-987-5979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberMA05047300
License Number StateNJ

VII. Legacy identifiers

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

# 1
Identifier060066695
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerRR MDCR #
# 2
Identifier2140120
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerAETNA HMO #
# 3
Identifier614P31
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerEMPIRE BCBS (255 LAFAYET)
# 4
Identifier0162507
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer
# 5
Identifier05D742
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerEMPIRE BCBS (30 PROSPECT)
# 6
Identifier2K7886
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerHEALTHNET #
# 7
Identifier8213937
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerGHI (PPO) #
# 8
IdentifierBS503
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerOXFORD #
# 9
Identifier05D743
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerEMPIRE BCBS (20 PROSPECT)
# 10
Identifier4346389
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerAETNA PPO #

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: