Individual
GYNETH JIMENEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
225 BROADHOLLOW RD STE 402, MELVILLE, NY 11747-4899
(631) 385-7780
Mailing address
53-38 96TH ST CORONA, CORONA, NY 11368
(347) 361-6934
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
03/12/2020
Last updated
03/12/2020
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