Individual provider Active NPI

Tashira Marie Jimenez

  • Specialist
  • Flushing, NY
National Provider Identifier
1306109202
Registry record updated Jun 17, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
891349 Issued in NY
Practice address
6750 164TH St
Apt5E
Flushing, NY 11365-3176
Phone
(347) 267-2672
Fax
(347) 960-9203
NPI assigned
Jun 17, 2012
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 17, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 891349 NY Primary

Addresses

Primary practice location

6750 164TH St
Apt5E
Flushing, NY 11365-3176

Mailing address

6750 164TH St
Apt5E
Flushing, NY 11365-3176
Phone (347) 267-2672

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
891349NYMDSpecialist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1339891200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1339891200000",
    "number": "1306109202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6750 164TH ST",
            "address_2": "APT5E",
            "city": "FLUSHING",
            "state": "NY",
            "postal_code": "113653176",
            "telephone_number": "347-267-2672",
            "fax_number": "347-960-9203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6750 164TH ST",
            "address_2": "APT5E",
            "city": "FLUSHING",
            "state": "NY",
            "postal_code": "113653176",
            "telephone_number": "347-267-2672",
            "fax_number": "347-960-9203"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JIMENEZ",
        "first_name": "TASHIRA",
        "middle_name": "MARIE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-06-17",
        "last_updated": "2012-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NY",
            "license": "891349",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Flushing, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.