Healthcare Provider Details

I. General information

NPI: 1821157702
Provider Name (Legal Business Name): EDUARDO GIMENEZ PHYSICAL THERAPIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 7TH AVE
NEW YORK NY
10001-6708
US

IV. Provider business mailing address

275 7TH AVE
NEW YORK NY
10001-6708
US

V. Phone/Fax

Practice location:
  • Phone: 212-924-2510
  • Fax: 212-929-8805
Mailing address:
  • Phone: 212-924-2510
  • Fax: 212-929-8805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number015391
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: