Provider Information for 1639621709
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ANTHONY L. JORDAN HEALTH CORPORATION
Organization Subpart: NO
NPI: 1639621709
Last Updated: 2016-10-25
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1639621709 | ||||||||
| Enumeration Date | 2016-10-25 | ||||||||
| NPI Type | NPI-2 Organization | ||||||||
| Status | Active | ||||||||
| Authorized Official Information | Name: YADITSY CANTERO Title: Credentialing specialist Phone: 5854232853 | ||||||||
| Mailing Address | 82 HOLLAND ST ROCHESTER, NY 14605-2131 United States Phone: 585-423-2816 | Fax:585-423-2853 | ||||||||
| Primary Practice Address | 82 HOLLAND ST ROCHESTER, NY 14605-2131 United States Phone: 585-423-2816 | Fax:585-423-2853 | ||||||||
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