Provider Demographics
NPI:1679679724
Name:ZIMMERMANN, PETER B (PH D)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:B
Last Name:ZIMMERMANN
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 CENTRAL PARK W
Mailing Address - Street 2:SUITE A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-6029
Mailing Address - Country:US
Mailing Address - Phone:212-787-3826
Mailing Address - Fax:212-787-7137
Practice Address - Street 1:230 CENTRAL PARK W
Practice Address - Street 2:SUITE A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-6029
Practice Address - Country:US
Practice Address - Phone:212-787-3826
Practice Address - Fax:212-787-7137
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000037101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000037OtherPSYCHOANALYST LICENSE
NYP83662OtherCERTIFICAT. PSYCHOANALYST