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General NPI Number Information
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NPI Number | 1396399515
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Entity Type | Individual
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Provider Name | PERCY J. JIMENEZ
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Gender | Male
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Dates
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Enumeration Date | 07/25/2019
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Last Update Date | 07/25/2019
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Provider Practice Location Address
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Address Line | 23 BEEKMAN ST
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City | STATEN ISLAND
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State | NY
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Zip | 10302-2006
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Country | US
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Telephone | 347-319-3009
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Fax |
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Provider Business Mailing Address
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Address Line | 23 BEEKMAN ST
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City | STATEN ISLAND
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State | NY
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Zip | 10302-2006
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Country | US
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Telephone | 347-319-3009
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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License Number | TTC-III-07-03-6989
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License Number State | PR
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