Provider Demographics
NPI:1093019440
Name:MARIA LUCIA JIMENEZ, MA,PT,PC
Entity Type:Organization
Organization Name:MARIA LUCIA JIMENEZ, MA,PT,PC
Other - Org Name:ELMHURST BALANCE & PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:M. LUCIA
Authorized Official - Middle Name:
Authorized Official - Last Name:JIMENEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MA, PT
Authorized Official - Phone:718-205-3435
Mailing Address - Street 1:9131 QUEENS BLVD
Mailing Address - Street 2:SUITE 314
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-5501
Mailing Address - Country:US
Mailing Address - Phone:718-205-3435
Mailing Address - Fax:718-205-2402
Practice Address - Street 1:9131 QUEENS BLVD
Practice Address - Street 2:SUITE 314
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-5501
Practice Address - Country:US
Practice Address - Phone:718-205-3435
Practice Address - Fax:718-205-2402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-28
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024486225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY9008690OtherCIGNA
NYQ072P1OtherEMPIRE BC/BS
NY03245654Medicaid
NYQ072P1OtherEMPIRE BC/BS