Individual provider Active NPI

Lilli Dash Zimmerman, MD

  • Reproductive Endocrinology Physician
  • New York, NY
National Provider Identifier
1104262153
Registry record updated Jul 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Reproductive Endocrinology PhysicianTaxonomy code 207VE0102X
License
289072 Issued in NY
Practice address
1790 Broadway PH
New York, NY 10019-1412
Phone
(646) 756-8282
NPI assigned
May 17, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X 289072 NY
Obstetrics & Gynecology Physician 207V00000X MT203588 PA
Reproductive Endocrinology Physician 207VE0102X 289072 NY Primary

Addresses

Primary practice location

1790 Broadway PH
New York, NY 10019-1412

Mailing address

1790 Broadway PH
New York, NY 10019-1412
Phone (646) 756-8282

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210911000146 NY Practitioner - Obstetrics/Gynecology 2062719859 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
289072NYMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
North Shore-Lij Medical PC Obstetrics & Gynecology CurrentSince Sep 13, 2021 Accepting new patients
Trustees of Columbia University in the City of New York Obstetrics & Gynecology PastSince Jun 28, 2020 Accepting new patients
Trustees of Columbia University in the Department of Otolaryngology PastSince Jun 28, 2020 Accepting new patients

Locations

300 Community Dr
Plandome, NY 11030

972 Brush Hollow Rd
Westbury, NY 11590

Interoperability endpoints

  • FHIR API: https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/R4/
  • FHIR API: https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/DSTU2/

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1368748800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626307200000",
    "number": "1104262153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1790 BROADWAY PH",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100191412",
            "telephone_number": "646-756-8282"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1790 BROADWAY PH",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100191412",
            "telephone_number": "646-756-8282"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZIMMERMAN",
        "first_name": "LILLI",
        "middle_name": "DASH",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-05-17",
        "last_updated": "2021-07-15",
        "certification_date": "2021-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NY",
            "license": "289072",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "PA",
            "license": "MT203588",
            "primary": false
        },
        {
            "code": "207VE0102X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Reproductive Endocrinology",
            "state": "NY",
            "license": "289072",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.