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General NPI Number Information
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NPI Number | 1790231199
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Entity Type | Individual
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Provider Name | MS. PATRICIA I JIMOH
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Gender | Female
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Dates
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Enumeration Date | 08/26/2016
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Last Update Date | 08/31/2016
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Provider Practice Location Address
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Address Line | 2038 SEAGIRT BLVD APT 4E FAR -ROCKAWAY NY 11691
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City | FAR ROCKAWAY
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State | NY
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Zip | 11691-5927
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Country | US
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Telephone | 917-496-0640
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Fax |
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Provider Business Mailing Address
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Address Line | 2038 SEAGIRT BLVD APT 4E FAR -ROCKAWAY NY 11691
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City | FAR ROCKAWAY
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State | NY
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Zip | 11691-5927
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Country | US
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Telephone | 917-496-0640
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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