Healthcare Provider Details

I. General information

NPI: 1134849268
Provider Name (Legal Business Name): JESSICA B RIMM OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2022
Last Update Date: 08/30/2022
Certification Date: 08/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 W 58TH ST STE 600
NEW YORK NY
10019-1817
US

IV. Provider business mailing address

330 W 58TH ST STE 330W58TH
NEW YORK NY
10019-1827
US

V. Phone/Fax

Practice location:
  • Phone: 212-204-0600
  • Fax: 212-600-5826
Mailing address:
  • Phone: 212-204-0600
  • Fax: 212-600-5826

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTUV009649
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: