Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225CX0006X | Orientation and Mobility Training Provider | NY |
NPI | 1720697212 |
---|---|
Provider Name | Rebecca Kim Jordan |
First Address | New York, NY 10025-9335 |
Second Address | New York, NY 10025-9335 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2020 |
Last Update Date | 30/07/2020 |