MEDICARE: DR. PETER B ZIMMERMANN PH. D.

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	101YM0800X	Mental Health Counselor	000037	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000037	OTHER	NY	PSYCHOANALYST LICENSE
2	P83662	OTHER	NY	CERTIFICAT. PSYCHOANALYST

General Provider Information

NPI Number	:	1679679724
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER B ZIMMERMANN PH. D.

Provider Business Mailing Address
First Line	:	230 CENTRAL PARK W
Second Line	:	SUITE A
City	:	NEW YORK
State	:	NY
Zip	:	10024-6029
Country	:	US
Telephone Number	:	212-787-3826
Fax Number	:	212-787-7137

Provider Business Practice Location Address
First Line	:	230 CENTRAL PARK W
Second Line	:	SUITE A
City	:	NEW YORK
State	:	NY
Zip	:	10024-6029
Country	:	US
Telephone Number	:	212-787-3826
Fax Number	:	212-787-7137

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

Provider Enumeration Date	:	09/16/2006
Last Update Date	:	07/08/2007

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