Provider Demographics
NPI:1093139974
Name:JIMENEZ, JASON PIMENTEL (OTR)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:PIMENTEL
Last Name:JIMENEZ
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
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Mailing Address - Street 1:264 CANAL ST
Mailing Address - Street 2:SUITE 6E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-3529
Mailing Address - Country:US
Mailing Address - Phone:212-925-8069
Mailing Address - Fax:646-224-8040
Practice Address - Street 1:264 CANAL ST
Practice Address - Street 2:SUITE 6E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-3529
Practice Address - Country:US
Practice Address - Phone:212-925-8069
Practice Address - Fax:646-224-8040
Is Sole Proprietor?:No
Enumeration Date:2014-02-12
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY012917225XG0600X, 225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation
No225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology