Healthcare Provider Details

I. General information

NPI: 1447254909
Provider Name (Legal Business Name): STEPHEN I. ZIMMERMAN P.T., D.P.T., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: STEPHEN I. ZIMMERMAN P.T., D.P.T., PH.D.

II. Dates (important events)

Enumeration Date: 06/11/2005
Last Update Date: 12/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2421 GRAND AVE
BALDWIN NY
11510-3219
US

IV. Provider business mailing address

2421 GRAND AVE
BALDWIN NY
11510-3219
US

V. Phone/Fax

Practice location:
  • Phone: 516-377-7964
  • Fax: 516-377-7760
Mailing address:
  • Phone: 516-377-7964
  • Fax: 516-377-7760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251E1300X
TaxonomyClinical Electrophysiology Physical Therapist
License Number
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number003994-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: