Healthcare Provider Details

I. General information

NPI: 1467520858
Provider Name (Legal Business Name): ALAN J. ZIMMERMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 EDEN RD
LIDO BEACH NY
11561-4815
US

IV. Provider business mailing address

17 EDEN RD
LIDO BEACH NY
11561-4815
US

V. Phone/Fax

Practice location:
  • Phone: 516-431-5559
  • Fax:
Mailing address:
  • Phone: 516-431-5559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number083620
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: