Healthcare Provider Details

I. General information

NPI: 1427135268
Provider Name (Legal Business Name): MARCIAL JIMENEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 06/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 E 188TH ST 1ST FLOOR
BRONX NY
10458-5402
US

IV. Provider business mailing address

320 E 188TH ST 1ST FLOOR
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 Number222831
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: