Provider Demographics
NPI:1962496935
Name:ZIMMERMAN, LEONARD (MD)
Entity type:Individual
Prefix:
First Name:LEONARD
Middle Name:
Last Name:ZIMMERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 GRAND ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:WARWICK
Mailing Address - State:NY
Mailing Address - Zip Code:10990-1035
Mailing Address - Country:US
Mailing Address - Phone:845-987-3952
Mailing Address - Fax:845-987-5979
Practice Address - Street 1:2 CROSFIELD AVE
Practice Address - Street 2:SUITE 318
Practice Address - City:WEST NYACK
Practice Address - State:NY
Practice Address - Zip Code:10994-2226
Practice Address - Country:US
Practice Address - Phone:845-353-5600
Practice Address - Fax:845-353-5668
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1064351207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
M101118OtherAETNA/USHC
0009322OtherGHI
NY00186801Medicaid
M4473575OtherAETNA
W07721OtherMEDICARE
02242088OtherMEDICAID
W07721Medicare UPIN
M101118OtherAETNA/USHC
657211Medicare ID - Type Unspecified