Provider Demographics
NPI:1861755472
Name:JIMENEZ, ADHARA (BS/AS)
Entity type:Individual
Prefix:MRS
First Name:ADHARA
Middle Name:
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:BS/AS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2277 GOSHEN TURNPIKE
Mailing Address - Street 2:AGES & STAGES
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10941
Mailing Address - Country:US
Mailing Address - Phone:845-692-7295
Mailing Address - Fax:845-692-4397
Practice Address - Street 1:2277 GOSHEN TPKE
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10941-4032
Practice Address - Country:US
Practice Address - Phone:845-692-7295
Practice Address - Fax:845-692-4397
Is Sole Proprietor?:No
Enumeration Date:2012-06-19
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator