Basic Information
| Provider Information | |||||||||
| NPI: | 1528036217 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ZIMMERMAN | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20 GRAND ST | ||||||||
| Address2: | FL 3 | ||||||||
| City: | WARWICK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109901035 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453688800 | ||||||||
| FaxNumber: | 8459875979 | ||||||||
| Practice Location | |||||||||
| Address1: | 20 PROSPECT AVE | ||||||||
| Address2: | STE 701 | ||||||||
| City: | HACKENSACK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076011997 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2019962997 | ||||||||
| FaxNumber: | 2019962571 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2006 | ||||||||
| LastUpdateDate: | 04/28/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0001X | MA05047300 | NJ | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology |
ID Information
| ID | Type | State | Issuer | Description | 060066695 | 01 | NJ | RR MDCR # | OTHER | 2140120 | 01 | NJ | AETNA HMO # | OTHER | 614P31 | 01 | NJ | EMPIRE BCBS (255 LAFAYET) | OTHER | 0162507 | 05 | NJ | MEDICAID | 05D742 | 01 | NJ | EMPIRE BCBS (30 PROSPECT) | OTHER | 2K7886 | 01 | NJ | HEALTHNET # | OTHER | 8213937 | 01 | NJ | GHI (PPO) # | OTHER | BS503 | 01 | NJ | OXFORD # | OTHER | 05D743 | 01 | NJ | EMPIRE BCBS (20 PROSPECT) | OTHER | 4346389 | 01 | NJ | AETNA PPO # | OTHER |