Provider Demographics
NPI:1164450300
Name:GITLIN, JORDAN S (MD)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:S
Last Name:GITLIN
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1999 MARCUS AVE
Mailing Address - Street 2:SUITE M18
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1017
Mailing Address - Country:US
Mailing Address - Phone:516-466-6953
Mailing Address - Fax:516-466-5608
Practice Address - Street 1:247 ROUTE 100
Practice Address - Street 2:SUITE 1002
Practice Address - City:SOMERS
Practice Address - State:NY
Practice Address - Zip Code:10589-3231
Practice Address - Country:US
Practice Address - Phone:914-962-8290
Practice Address - Fax:914-962-8851
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2014-01-29
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Provider Licenses
StateLicense IDTaxonomies
NY203315208800000X, 2088P0231X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric Urology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02298126Medicaid
NY59T061Medicare PIN
NYG76768Medicare UPIN