MEDICARE: DR. WENDY E ZIMMER MD

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	2085R0202X	Diagnostic Radiology Physician	ME131480	FL
2	2085R0202X	Diagnostic Radiology Physician	198865	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
6	P00080287	OTHER		RR MEDICARE
15	P00051276	OTHER		RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00020544503	OTHER		UNIVERA
2	0142860	OTHER		GHI
3	5607163	OTHER		INDEPENDENT HEALTH
4	000523662007	OTHER		BLUE SHIELD WNY
5	197246FF	OTHER		PREFERRED CARE
7	00020544502	OTHER		UNIVERA
8	000523662009	OTHER		BLUE SHIELD WNY
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	040426001964	OTHER		FIDELIS
11	P010198865	OTHER		BLUE CHOICE
12	P020198865	OTHER		BLUE SHIELD ROCHESTER
13	1988658W	OTHER	NY	WORKERS COMPENSATION
14	4195244	OTHER		GHI
16	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568420149
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WENDY E ZIMMER MD

Provider Business Mailing Address
First Line	:	199 PARK CLUB LN STE 300
Second Line	:
City	:	WILLIAMSVILLE
State	:	NY
Zip	:	14221-5269
Country	:	US
Telephone Number	:	716-836-4646
Fax Number	:	716-836-4696

Provider Business Practice Location Address
First Line	:	199 PARK CLUB LN STE 300
Second Line	:
City	:	WILLIAMSVILLE
State	:	NY
Zip	:	14221-5269
Country	:	US
Telephone Number	:	716-836-4646
Fax Number	:	716-836-4696

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

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	02/11/2025

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