Healthcare Provider Details

I. General information

NPI: 1205237344
Provider Name (Legal Business Name): ERIC H. ZIMAK PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2014
Last Update Date: 07/13/2023
Certification Date: 07/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CENTER FOR NEUROPSYCHOLOGICAL SERVICES MSC 09 5030, 1 UNIVERSITY OF NEW MEXICO
ALBUQUERQUE NM
87131-0001
US

IV. Provider business mailing address

CENTER FOR NEUROPSYCHOLOGICAL SERVICES MSC 09 5030, 1 UNIVERSITY OF NEW MEXICO
ALBUQUERQUE NM
87131-0001
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-8833
  • Fax: 505-272-8316
Mailing address:
  • Phone: 505-272-8833
  • Fax: 505-272-8316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number1346
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: