Healthcare Provider Details

I. General information

NPI: 1093139974
Provider Name (Legal Business Name): JASON PIMENTEL JIMENEZ OTR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2014
Last Update Date: 05/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

264 CANAL ST SUITE 6E
NEW YORK NY
10013-3529
US

IV. Provider business mailing address

264 CANAL ST SUITE 6E
NEW YORK NY
10013-3529
US

V. Phone/Fax

Practice location:
  • Phone: 212-925-8069
  • Fax: 646-224-8040
Mailing address:
  • Phone: 212-925-8069
  • Fax: 646-224-8040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License Number012917
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number012917
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: