Provider Demographics
NPI:1689800328
Name:JIMENEZ, SORELIS (DPM)
Entity Type:Individual
Prefix:DR
First Name:SORELIS
Middle Name:
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:240 EAST 76 STREET
Mailing Address - Street 2:APT. 8H
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021
Mailing Address - Country:US
Mailing Address - Phone:347-564-6180
Mailing Address - Fax:212-734-8588
Practice Address - Street 1:1090 AMSTERDAM AVENUE
Practice Address - Street 2:SUITE 10C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-1737
Practice Address - Country:US
Practice Address - Phone:212-845-9991
Practice Address - Fax:212-864-2494
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-09
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN006307213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery