Provider Demographics
NPI:1700059201
Name:ZIMMERMAN, JAMES KUPER (PHD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:KUPER
Last Name:ZIMMERMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 ACADEMY ST
Mailing Address - Street 2:
Mailing Address - City:PLEASANTVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10570-2023
Mailing Address - Country:US
Mailing Address - Phone:914-741-6240
Mailing Address - Fax:914-741-6240
Practice Address - Street 1:61 ACADEMY ST
Practice Address - Street 2:
Practice Address - City:PLEASANTVILLE
Practice Address - State:NY
Practice Address - Zip Code:10570-2023
Practice Address - Country:US
Practice Address - Phone:914-741-6240
Practice Address - Fax:914-741-6240
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-07
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010118103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV58751Medicare UPIN