Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 22D100853700 | NJ |
Y | 213EG0000X | General Practice | 22D100853700 | NJ |
NPI | 1942486410 |
---|---|
Provider Name | Dr. Sam David Zimmerman |
First Address | Oceanport, NJ 07757-1191 |
Second Address | Oceanport, NJ 07757-1191 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/01/2008 |
Last Update Date | 08/12/2008 |