Provider Demographics
NPI:1679520084
Name:ZIMMERMAN, WARREN (OD)
Entity type:Individual
Prefix:DR
First Name:WARREN
Middle Name:
Last Name:ZIMMERMAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:344 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-2331
Mailing Address - Country:US
Mailing Address - Phone:212-679-9690
Mailing Address - Fax:212-779-8406
Practice Address - Street 1:344 3RD AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-2331
Practice Address - Country:US
Practice Address - Phone:212-679-9690
Practice Address - Fax:212-779-8406
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-30
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV3510152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0749390001Medicare NSC
NYC30851Medicare PIN
NYU42780Medicare UPIN