Healthcare Provider Details

I. General information

NPI: 1124939152
Provider Name (Legal Business Name): JASON JIMENEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2480 BELMONT AVE APT 13
BRONX NY
10458-6239
US

IV. Provider business mailing address

2480 BELMONT AVE APT 13
BRONX NY
10458-6239
US

V. Phone/Fax

Practice location:
  • Phone: 917-859-0347
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: