Healthcare Provider Details

I. General information

NPI: 1912902180
Provider Name (Legal Business Name): JAY S ZIMMERMAN OD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3095 HARLEM RD
CHEEKTOWAGA NY
14225-2500
US

IV. Provider business mailing address

3095 HARLEM RD
CHEEKTOWAGA NY
14225-2500
US

V. Phone/Fax

Practice location:
  • Phone: 716-896-8831
  • Fax: 716-896-2318
Mailing address:
  • Phone: 716-896-8831
  • Fax: 716-896-2318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTUV006778
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: