Healthcare Provider Details

I. General information

NPI: 1295855005
Provider Name (Legal Business Name): LUIS JIMENEZ X M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1265 FRANKLIN AVE
BRONX NY
10456-3501
US

IV. Provider business mailing address

PO BOX 743
NEW YORK NY
10033-0596
US

V. Phone/Fax

Practice location:
  • Phone: 718-503-7700
  • Fax: 718-503-7712
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number138818
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: