Provider Demographics
NPI:1447254909
Name:ZIMMERMAN, STEPHEN I (PT, DPT, PHD)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:I
Last Name:ZIMMERMAN
Suffix:
Gender:M
Credentials:PT, DPT, PHD
Other - Prefix:DR
Other - First Name:STEPHEN
Other - Middle Name:I
Other - Last Name:ZIMMERMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT, DPT, PHD
Mailing Address - Street 1:2421 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-3219
Mailing Address - Country:US
Mailing Address - Phone:516-377-7964
Mailing Address - Fax:516-377-7760
Practice Address - Street 1:2421 GRAND AVE
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-3219
Practice Address - Country:US
Practice Address - Phone:516-377-7964
Practice Address - Fax:516-377-7760
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-11
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2251E1300X
NY003994-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251E1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistElectrophysiology, Clinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY145529POtherHIP PROVIDER #
NY46295OtherVYTRA
NY6698763OtherGHI PROVIDER #
NYQM8451OtherEMPIRE BC/BS PROV. #
NY00336567Medicaid
NY0731899OtherCIGNA PROVIDER #
NY51201OtherCIGNA/ORTHONET PROV. #
NY259759OtherUNITED HEALTHCARE PROV. #
NYAZ00575OtherMDNY PROVIDER #
NY6698763OtherGHI PROVIDER #
NYQ53263Medicare ID - Type UnspecifiedMEDICARE PROVIDER #