Provider Demographics
NPI:1689789323
Name:JIMENEZ, WILLIAM MARQUEZ (MD)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:MARQUEZ
Last Name:JIMENEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 WESTCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:PURCHASE
Mailing Address - State:NY
Mailing Address - Zip Code:10577-2547
Mailing Address - Country:US
Mailing Address - Phone:212-724-6780
Mailing Address - Fax:212-580-6610
Practice Address - Street 1:470 WEST END AVENUE
Practice Address - Street 2:SUITE 1B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024
Practice Address - Country:US
Practice Address - Phone:212-724-6780
Practice Address - Fax:212-580-6610
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY202809207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01745353Medicaid
NY785321Medicare ID - Type Unspecified
G54048Medicare UPIN