Provider Demographics
NPI:1366196271
Name:ZIMMERMAN, CHRISTIAN (PA-C)
Entity type:Individual
Prefix:MR
First Name:CHRISTIAN
Middle Name:
Last Name:ZIMMERMAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3670 S BENZING RD STE A
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-1741
Mailing Address - Country:US
Mailing Address - Phone:716-662-5357
Mailing Address - Fax:
Practice Address - Street 1:3670 S BENZING RD
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-1737
Practice Address - Country:US
Practice Address - Phone:716-662-5357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-09
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
NY027985363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant