MEDICARE: GREGG E. ZIMMERMAN 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	208800000X	Urology Physician	25MA08076700	NJ

General Provider Information

NPI Number	:	1790766228
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGG E. ZIMMERMAN MD

Provider Business Mailing Address
First Line	:	16 POCONO RD
Second Line	:	SUITE 205
City	:	DENVILLE
State	:	NJ
Zip	:	07834-2901
Country	:	US
Telephone Number	:	973-627-0060
Fax Number	:	973-627-6821

Provider Business Practice Location Address
First Line	:	16 POCONO RD
Second Line	:	SUITE 205
City	:	DENVILLE
State	:	NJ
Zip	:	07834-2901
Country	:	US
Telephone Number	:	973-627-0060
Fax Number	:	973-627-6821

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

Provider Enumeration Date	:	11/10/2005
Last Update Date	:	06/18/2010

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