Individual
DR. JONATHAN LANDIS ZIMMERMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1001 BROADWAY STE 223, ESOPUS, NY 12429-2500
(845) 658-7763
Mailing address
10 HELLBROOK LN, ULSTER PARK, NY 12487-5209
(845) 658-7763
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
180313
NY
207Q00000X
Family Medicine Physician
Primary
MD043137L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001676516-0005
—
PA
05
—
02160103
—
NY
01
—
180313
NY LICENSE NUMBER
NY
01
—
193813
HMO ULSTER PARK NUMBER
NY
01
—
217168
HMO ELKA PARK NUMBER
NY
01
—
MD043137L
LICENSE
PA
Enumeration date
02/24/2006
Last updated
03/07/2023
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