Provider Demographics
NPI:1376579060
Name:ZIMMERLING, INNA (OD)
Entity type:Individual
Prefix:
First Name:INNA
Middle Name:
Last Name:ZIMMERLING
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:538 UNDERCLIFF AVE
Mailing Address - Street 2:UNIT B
Mailing Address - City:EDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:07020-1310
Mailing Address - Country:US
Mailing Address - Phone:201-218-4485
Mailing Address - Fax:
Practice Address - Street 1:7733 BERGENLINE AVE
Practice Address - Street 2:
Practice Address - City:NORTH BERGEN
Practice Address - State:NJ
Practice Address - Zip Code:07047-7134
Practice Address - Country:US
Practice Address - Phone:201-868-1021
Practice Address - Fax:201-868-2960
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-24
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00584700152W00000X, 152WC0802X
NJ1245152W00000X
NY006841152W00000X
NYTUV00684100152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U80982Medicare UPIN
NYC431D1Medicare Oscar/Certification