Provider Demographics
NPI:1396413589
Name:CONNECTED HEALTH MEDICINE PC
Entity Type:Organization
Organization Name:CONNECTED HEALTH MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CMO
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDRES
Authorized Official - Middle Name:
Authorized Official - Last Name:JIMENEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-989-5503
Mailing Address - Street 1:80 THEODORE FREMD AVE
Mailing Address - Street 2:
Mailing Address - City:RYE
Mailing Address - State:NY
Mailing Address - Zip Code:10580-2891
Mailing Address - Country:US
Mailing Address - Phone:800-989-5503
Mailing Address - Fax:
Practice Address - Street 1:80 THEODORE FREMD AVE
Practice Address - Street 2:
Practice Address - City:RYE
Practice Address - State:NY
Practice Address - Zip Code:10580-2891
Practice Address - Country:US
Practice Address - Phone:800-989-5503
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-01
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care