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General NPI Number Information
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NPI Number | 1891339867
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Entity Type | Individual
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Provider Name | YELISA JIMENEZ
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Gender | Female
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Dates
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Enumeration Date | 11/03/2019
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Last Update Date | 08/01/2023
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Provider Practice Location Address
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Address Line | 1275 YORK AVE
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City | NEW YORK
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State | NY
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Zip | 10065-6007
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Country | US
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Telephone | 917-407-3388
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Fax |
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Provider Business Mailing Address
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Address Line | 69 BANK ST
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City | VALLEY STREAM
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State | NY
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Zip | 11580-1005
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Country | US
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Telephone | 917-407-3388
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 309441
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License Number State | NY
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