Provider Demographics
NPI:1407925779
Name:KLESMER, JORDAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:
Last Name:KLESMER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JORDAN
Other - Middle Name:
Other - Last Name:KLESMER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1 BARSTOW RD
Mailing Address - Street 2:SUITE P24
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-3501
Mailing Address - Country:US
Mailing Address - Phone:516-477-2430
Mailing Address - Fax:
Practice Address - Street 1:1 BARSTOW RD
Practice Address - Street 2:SUITE P24
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-3501
Practice Address - Country:US
Practice Address - Phone:516-477-2430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1705362084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWXW451Medicare UPIN
NY93F13XW451Medicare UPIN