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NPI Code Detail

MEDICARE: MS. JACLYN ZIMMEL B.S.

MEDICARE: MS. JACLYN ZIMMEL B.S.
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
1174400000XSpecialistNY

General Provider Information

NPI Number : 1891057220
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JACLYN ZIMMEL B.S.
Provider Business Mailing Address
First Line : 5940 QUEENS BLVD
Second Line :
City : WOODSIDE
State : NY
Zip : 11377-7758
Country : US
Telephone Number : 347-208-2966
Fax Number :
Provider Business Practice Location Address
First Line : 3004 146TH ST
Second Line :
City : FLUSHING
State : NY
Zip : 11354-2324
Country : US
Telephone Number : 347-208-2966
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/12/2012
Last Update Date : 06/12/2012

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