Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 150448 | NY |
NPI | 1649230251 |
---|---|
Provider Name | Dr. Barry D Jordan |
First Address | Bronx, NY 10465-0362 |
Second Address | White Plains, NY 10605-2523 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
150448 | STATE LICENSE (01) | NY |
B11381 | (02) | NY |