Healthcare Provider Details

I. General information

NPI: 1437310448
Provider Name (Legal Business Name): JOSEPH JIMENEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2008
Last Update Date: 05/12/2021
Certification Date: 05/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

952 MAIN ST
HACKENSACK NJ
07601-5171
US

IV. Provider business mailing address

952 MAIN ST
HACKENSACK NJ
07601-5171
US

V. Phone/Fax

Practice location:
  • Phone: 201-724-1856
  • Fax:
Mailing address:
  • Phone: 201-880-1400
  • Fax: 201-604-5451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number25MA08277400
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number25MA08277400
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: