Healthcare Provider Details

I. General information

NPI: 1417986928
Provider Name (Legal Business Name): GARY ALLEN ZIMMERMANN ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 FAIRWAY BLVD
WILTON NY
12831-1750
US

IV. Provider business mailing address

40 FAIRWAY BLVD
WILTON NY
12831-1750
US

V. Phone/Fax

Practice location:
  • Phone: 518-581-7115
  • Fax:
Mailing address:
  • Phone: 518-581-7115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number001398
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: