Provider Demographics
NPI:1194854497
Name:JIMENEZ, CLARA INES (MS)
Entity Type:Individual
Prefix:MRS
First Name:CLARA
Middle Name:INES
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 LAWRENCE ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-3018
Mailing Address - Country:US
Mailing Address - Phone:516-586-5172
Mailing Address - Fax:516-694-4686
Practice Address - Street 1:100 LAWRENCE ST
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-3018
Practice Address - Country:US
Practice Address - Phone:516-586-5172
Practice Address - Fax:516-694-4686
Is Sole Proprietor?:No
Enumeration Date:2007-03-04
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor