Provider Demographics
NPI:1023040979
Name:NEE, JIMMY (PA)
Entity type:Individual
Prefix:
First Name:JIMMY
Middle Name:
Last Name:NEE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 W 124TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-4920
Mailing Address - Country:US
Mailing Address - Phone:212-531-1300
Mailing Address - Fax:212-531-0141
Practice Address - Street 1:123 W 124TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-4920
Practice Address - Country:US
Practice Address - Phone:212-531-1300
Practice Address - Fax:212-531-0141
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009576363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant