Provider Demographics
NPI:1164522678
Name:ROSENSTOCK, JORDAN L (MD)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:L
Last Name:ROSENSTOCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:130 E 77TH ST
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-1851
Mailing Address - Country:US
Mailing Address - Phone:212-988-8149
Mailing Address - Fax:212-734-2133
Practice Address - Street 1:130 E 77TH ST
Practice Address - Street 2:5TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-1851
Practice Address - Country:US
Practice Address - Phone:212-988-8149
Practice Address - Fax:212-734-2133
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY217363207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02267150Medicaid
NYH68244Medicare UPIN
NY6X7121Medicare ID - Type Unspecified
NY02267150Medicaid