MEDICARE: BELLA ZIMILEVICH M.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	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	045858	CT
2	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	251120	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	251120	OTHER	NY	LICENSE
2	045858	OTHER	CT	LICENSE

General Provider Information

NPI Number	:	1972799161
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BELLA ZIMILEVICH M.D.

Provider Business Mailing Address
First Line	:	6301 MILL LN
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-5512
Country	:	US
Telephone Number	:	718-942-4600
Fax Number	:

Provider Business Practice Location Address
First Line	:	6301 MILL LN
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-5512
Country	:	US
Telephone Number	:	718-942-4600
Fax Number	:	718-942-4605

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

Provider Enumeration Date	:	09/20/2007
Last Update Date	:	05/06/2014

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