Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 124104 | NY |
NPI | 1003814682 |
---|---|
Provider Name | Dr. Alan J Jordan |
First Address | Brooklyn, NY 11201-2712 |
Second Address | Brooklyn, NY 11201-2712 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2005 |
Last Update Date | 29/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00363819 | (05) | NY |
C04954 | (02) | NY |