Healthcare Provider Details

I. General information

NPI: 1962496935
Provider Name (Legal Business Name): LEONARD ZIMMERMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 03/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 CROSFIELD AVE SUITE 318
WEST NYACK NY
10994-2226
US

IV. Provider business mailing address

20 GRAND ST 3RD FLOOR
WARWICK NY
10990-1035
US

V. Phone/Fax

Practice location:
  • Phone: 845-353-5600
  • Fax: 845-353-5668
Mailing address:
  • Phone: 845-987-3952
  • Fax: 845-987-5979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number1064351
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: