MEDICARE: MR. GARY ALLEN ZIMMERMANN ATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	001398	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	901750GZ	OTHER	NY	ATC

General Provider Information

NPI Number	:	1417986928
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GARY ALLEN ZIMMERMANN ATC

Provider Business Mailing Address
First Line	:	40 FAIRWAY BLVD
Second Line	:
City	:	WILTON
State	:	NY
Zip	:	12831-1750
Country	:	US
Telephone Number	:	518-581-7115
Fax Number	:

Provider Business Practice Location Address
First Line	:	40 FAIRWAY BLVD
Second Line	:
City	:	WILTON
State	:	NY
Zip	:	12831-1750
Country	:	US
Telephone Number	:	518-581-7115
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2006
Last Update Date	:	07/08/2007

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