Provider Demographics
NPI:1427027549
Name:DEJORDY, JOHN O (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:O
Last Name:DEJORDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1753 ROUTE 3
Mailing Address - Street 2:ADIRONDACK DERMATOLOGY PC
Mailing Address - City:MORRISONVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12962
Mailing Address - Country:US
Mailing Address - Phone:518-563-7546
Mailing Address - Fax:518-562-5458
Practice Address - Street 1:1753 ROUTE 3
Practice Address - Street 2:ADIRONDACK DERMATOLOGY PC
Practice Address - City:MORRISONVILLE
Practice Address - State:NY
Practice Address - Zip Code:12962
Practice Address - Country:US
Practice Address - Phone:518-563-7546
Practice Address - Fax:518-562-5458
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2016181207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G22393Medicare UPIN
55946AMedicare ID - Type Unspecified