Provider Demographics
NPI:1295784866
Name:RIMMER, CHERYL (MD)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:RIMMER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 SANTA CRUZ RD
Mailing Address - Street 2:
Mailing Address - City:TUCKERTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08087-4251
Mailing Address - Country:US
Mailing Address - Phone:609-294-1480
Mailing Address - Fax:
Practice Address - Street 1:544 NEW JERSEY AVE
Practice Address - Street 2:
Practice Address - City:ABSECON
Practice Address - State:NJ
Practice Address - Zip Code:08201-2425
Practice Address - Country:US
Practice Address - Phone:609-441-2147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08012800207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0104272Medicaid
NJP00953436OtherR R MCR
NJ1125315OtherBLUE CROSS BLUE SHIELD
NJP00953436OtherR R MCR
NJ0104272Medicaid
NJ101717CXLMedicare PIN
NJ101717CTAMedicare PIN