Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XG0600X | Occupational Therapist - Gerontology | 012917 | NY |
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 012917 | NY |
NPI | 1093139974 |
---|---|
Provider Name | Mr. Jason Pimentel Jimenez |
First Address | New York, NY 10013-3529 |
Second Address | New York, NY 10013-3529 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2014 |
Last Update Date | 20/05/2015 |