Provider Demographics
NPI:1104942879
Name:ZIMMEL, DOUGLAS JAY (DC)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:JAY
Last Name:ZIMMEL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:940 AMBOY AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08837-2811
Mailing Address - Country:US
Mailing Address - Phone:732-738-1800
Mailing Address - Fax:732-738-8110
Practice Address - Street 1:940 AMBOY AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08837-2811
Practice Address - Country:US
Practice Address - Phone:732-738-1800
Practice Address - Fax:732-738-8110
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ3245111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ580071Medicare ID - Type Unspecified