Provider Demographics
NPI:1427117241
Name:DR. MITCHELL T. ZIMMEL PA
Entity type:Organization
Organization Name:DR. MITCHELL T. ZIMMEL PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:T
Authorized Official - Last Name:ZIMMEL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:732-224-0800
Mailing Address - Street 1:180 WHITE RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:LITTLE SILVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07739-1166
Mailing Address - Country:US
Mailing Address - Phone:732-224-0800
Mailing Address - Fax:732-224-0918
Practice Address - Street 1:180 WHITE RD
Practice Address - Street 2:SUITE 105
Practice Address - City:LITTLE SILVER
Practice Address - State:NJ
Practice Address - Zip Code:07739-1166
Practice Address - Country:US
Practice Address - Phone:732-224-0800
Practice Address - Fax:732-224-0918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-07
Last Update Date:2009-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00196200213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ098094Medicare ID - Type UnspecifiedGROUP NUMBER
NJ5974070001Medicare NSC