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NPI Code Detail

MEDICARE: ELIZABETH JO ANN JIMENEZ DOUGLAS PA

MEDICARE: ELIZABETH JO ANN JIMENEZ DOUGLAS PA
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
1363A00000XPhysician Assistant

General Provider Information

NPI Number : 1659115483
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIZABETH JO ANN JIMENEZ DOUGLAS PA
Provider Business Mailing Address
First Line : 177 FORT WASHINGTON AVE
Second Line :
City : NEW YORK
State : NY
Zip : 10032-3733
Country : US
Telephone Number : 212-305-2633
Fax Number : 212-305-2439
Provider Business Practice Location Address
First Line : 177 FORT WASHINGTON AVE
Second Line :
City : NEW YORK
State : NY
Zip : 10032-3733
Country : US
Telephone Number : 212-305-2500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/25/2024
Last Update Date : 03/08/2026

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