Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 084833 | NY |
NPI | 1245240720 |
---|---|
Provider Name | Jordan Meyers |
First Address | Brooklyn, NY 11234-3910 |
Second Address | Brooklyn, NY 11234-3910 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2006 |
Last Update Date | 02/11/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B77717 | (02) | NY |