Healthcare Provider Details

I. General information

NPI: 1164613857
Provider Name (Legal Business Name): MEDIKIDS PEDIATRICS MEDICINE II PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2007
Last Update Date: 06/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 E 188TH ST
BRONX NY
10458-5402
US

IV. Provider business mailing address

320 E 188TH ST
BRONX NY
10458-5402
US

V. Phone/Fax

Practice location:
  • Phone: 718-220-2804
  • Fax: 718-220-5321
Mailing address:
  • Phone: 718-220-2804
  • Fax: 718-220-5321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MARCIAL JIMENEZ
Title or Position: PEDIATRICIAN
Credential: M.D.
Phone: 718-220-2804