Basic Information
| Provider Information | |||||||||
| NPI: | 1962496935 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ZIMMERMAN | ||||||||
| FirstName: | LEONARD | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20 GRAND ST | ||||||||
| Address2: | 3RD FLOOR | ||||||||
| City: | WARWICK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109901035 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8459873952 | ||||||||
| FaxNumber: | 8459875979 | ||||||||
| Practice Location | |||||||||
| Address1: | 2 CROSFIELD AVE | ||||||||
| Address2: | SUITE 318 | ||||||||
| City: | WEST NYACK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109942226 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453535600 | ||||||||
| FaxNumber: | 8453535668 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2005 | ||||||||
| LastUpdateDate: | 03/15/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 1064351 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | M101118 | 01 | AETNA/USHC | OTHER | 0009322 | 01 | GHI | OTHER | 00186801 | 05 | NY | MEDICAID | M4473575 | 01 | AETNA | OTHER | W07721 | 01 | MEDICARE | OTHER | 02242088 | 01 | MEDICAID | OTHER |