Provider Demographics
NPI:1396906178
Name:DIAZ-JIMENEZ, JOSE EDUARDO (MD)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:EDUARDO
Last Name:DIAZ-JIMENEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1812 SHADBUSH CT
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08094-3389
Mailing Address - Country:US
Mailing Address - Phone:856-905-4881
Mailing Address - Fax:
Practice Address - Street 1:380 EGG HARBOR RD
Practice Address - Street 2:
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-3152
Practice Address - Country:US
Practice Address - Phone:856-589-1151
Practice Address - Fax:856-589-1554
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-24
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06610100208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice