Healthcare Provider Details

I. General information

NPI: 1952595514
Provider Name (Legal Business Name): MRS. PATRICIA JIMENEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PATTY JIMENEZ PT

II. Dates (important events)

Enumeration Date: 08/28/2007
Last Update Date: 01/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 W END AVE EARLY CHILDHOOD ASSOCIATES
NEW YORK NY
10025-5349
US

IV. Provider business mailing address

275 W 96TH ST APT 3B
NEW YORK NY
10025-6264
US

V. Phone/Fax

Practice location:
  • Phone: 212-662-9200
  • Fax:
Mailing address:
  • Phone: 917-828-4223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number018275
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: