Provider Demographics
NPI:1841975877
Name:JIMENEZ, STEFANY (LMT)
Entity type:Individual
Prefix:
First Name:STEFANY
Middle Name:
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6916 164TH ST APT 1D
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365-3153
Mailing Address - Country:US
Mailing Address - Phone:929-608-6662
Mailing Address - Fax:
Practice Address - Street 1:6916 164TH ST APT 1D
Practice Address - Street 2:
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11365-3153
Practice Address - Country:US
Practice Address - Phone:929-608-6662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032549-00225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist