Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NI0013X | Independent Medical Examiner | X009940 | NY |
NPI | 1487875092 |
---|---|
Provider Name | Dr. Gerald Mark Jordan |
First Address | New Paltz, NY 12561 |
Second Address | New Paltz, NY 12561 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2007 |
Last Update Date | 08/07/2007 |