Healthcare Provider Details

I. General information

NPI: 1740202704
Provider Name (Legal Business Name): MARK BERNARD ZIMERING M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 KNOLLCROFT RD MEDICAL 111 VA HOSPITAL
LYONS NJ
07939-5001
US

IV. Provider business mailing address

151 KNOLLCROFT RD MEDICAL 111 VA HOSPITAL
LYONS NJ
07939-5001
US

V. Phone/Fax

Practice location:
  • Phone: 908-647-0180
  • Fax: 908-604-5248
Mailing address:
  • Phone: 908-647-0180
  • Fax: 908-604-5248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberMA056415
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: