Provider Demographics
NPI:1114427721
Name:BEL, JORDANA KOZUPSKY
Entity Type:Individual
Prefix:
First Name:JORDANA
Middle Name:KOZUPSKY
Last Name:BEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 N BROADWAY STE 207
Mailing Address - Street 2:
Mailing Address - City:SLEEPY HOLLOW
Mailing Address - State:NY
Mailing Address - Zip Code:10591-1019
Mailing Address - Country:US
Mailing Address - Phone:914-366-3677
Mailing Address - Fax:914-269-1868
Practice Address - Street 1:777 N BROADWAY STE 207
Practice Address - Street 2:
Practice Address - City:SLEEPY HOLLOW
Practice Address - State:NY
Practice Address - Zip Code:10591-1019
Practice Address - Country:US
Practice Address - Phone:914-366-3677
Practice Address - Fax:914-269-1868
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-20
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY308587363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health