Provider Demographics
NPI:1609000728
Name:JIMENEZ, PABLO DAVID (MS, SLP)
Entity Type:Individual
Prefix:
First Name:PABLO
Middle Name:DAVID
Last Name:JIMENEZ
Suffix:
Gender:M
Credentials:MS, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:247 JOHNSON AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11206-2813
Mailing Address - Country:US
Mailing Address - Phone:347-653-1799
Mailing Address - Fax:
Practice Address - Street 1:247 JOHNSON AVE APT 2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-2813
Practice Address - Country:US
Practice Address - Phone:347-653-1799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-04
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017982235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist