MEDICARE: JOHANNY JIMENEZ

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	174400000X	Specialist	088856-1	NY

General Provider Information

NPI Number	:	1407117500
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHANNY JIMENEZ

Provider Business Mailing Address
First Line	:	15 POST AVE
Second Line	:	APT 3G
City	:	NEW YORK
State	:	NY
Zip	:	10034-5844
Country	:	US
Telephone Number	:	718-812-5425
Fax Number	:

Provider Business Practice Location Address
First Line	:	2336 ANDREWS AVE
Second Line	:	2ND FLOOR
City	:	BRONX
State	:	NY
Zip	:	10468-6001
Country	:	US
Telephone Number	:	718-561-5300
Fax Number	:

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

Provider Enumeration Date	:	06/05/2012
Last Update Date	:	11/26/2014

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Directions to “ JOHANNY JIMENEZ ” Practice Location

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