Provider Demographics
NPI:1164613857
Name:MEDIKIDS PEDIATRICS MEDICINE II PLLC
Entity Type:Organization
Organization Name:MEDIKIDS PEDIATRICS MEDICINE II PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MARCIAL
Authorized Official - Middle Name:
Authorized Official - Last Name:JIMENEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-220-2804
Mailing Address - Street 1:320 E 188TH ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-5402
Mailing Address - Country:US
Mailing Address - Phone:718-220-2804
Mailing Address - Fax:718-220-5321
Practice Address - Street 1:320 E 188TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-5402
Practice Address - Country:US
Practice Address - Phone:718-220-2804
Practice Address - Fax:718-220-5321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-07
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02218124Medicaid