Provider Demographics
NPI:1952595514
Name:JIMENEZ, PATRICIA
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PATTY
Other - Middle Name:
Other - Last Name:JIMENEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:275 W 96TH ST APT 3B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-6264
Mailing Address - Country:US
Mailing Address - Phone:917-828-4223
Mailing Address - Fax:
Practice Address - Street 1:825 W END AVE
Practice Address - Street 2:EARLY CHILDHOOD ASSOCIATES
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-5349
Practice Address - Country:US
Practice Address - Phone:212-662-9200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-28
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0182752251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics