Provider Demographics
NPI:1790231199
Name:JIMOH, PATRICIA I
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:I
Last Name:JIMOH
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:PATRICIA
Other - Middle Name:I
Other - Last Name:JIMOH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2038 SEAGIRT BLVD APT 4E
Mailing Address - Street 2:FAR -ROCKAWAY NY 11691
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-5927
Mailing Address - Country:US
Mailing Address - Phone:917-496-0640
Mailing Address - Fax:
Practice Address - Street 1:2038 SEAGIRT BLVD APT 4E
Practice Address - Street 2:FAR -ROCKAWAY NY 11691
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-5927
Practice Address - Country:US
Practice Address - Phone:917-496-0640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-26
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator