MEDICARE: MR. ALEX JIMENEZ ALEX

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1306476270
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ALEX JIMENEZ ALEX

Provider Business Mailing Address
First Line	:	122 LOCUST AVE
Second Line	:
City	:	NORTH ARLINGTON
State	:	NJ
Zip	:	07031-5513
Country	:	US
Telephone Number	:	973-393-8261
Fax Number	:

Provider Business Practice Location Address
First Line	:	122 LOCUST AVE
Second Line	:
City	:	NORTH ARLINGTON
State	:	NJ
Zip	:	07031-5513
Country	:	US
Telephone Number	:	973-393-8261
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/20/2020
Last Update Date	:	01/20/2020

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