Provider Demographics
NPI:1922219336
Name:JIMENEZ, EDWARD ALEXANDER (DO)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:ALEXANDER
Last Name:JIMENEZ
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:200 OLD COUNTRY RD
Mailing Address - Street 2:SUITE 365
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-4235
Mailing Address - Country:US
Mailing Address - Phone:516-294-5440
Mailing Address - Fax:516-294-1206
Practice Address - Street 1:200 OLD COUNTRY RD
Practice Address - Street 2:SUITE 365
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-4235
Practice Address - Country:US
Practice Address - Phone:516-294-5440
Practice Address - Fax:516-294-1206
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2021-03-19
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Provider Licenses
StateLicense IDTaxonomies
NY255535207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology