Provider Demographics
NPI:1467480293
Name:JORDAN, NED C (RPA-C)
Entity Type:Individual
Prefix:
First Name:NED
Middle Name:C
Last Name:JORDAN
Suffix:
Gender:M
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9820 S STREET RD
Mailing Address - Street 2:
Mailing Address - City:LE ROY
Mailing Address - State:NY
Mailing Address - Zip Code:14482-8815
Mailing Address - Country:US
Mailing Address - Phone:585-768-2022
Mailing Address - Fax:585-591-6962
Practice Address - Street 1:107 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:ATTICA
Practice Address - State:NY
Practice Address - Zip Code:14011-1149
Practice Address - Country:US
Practice Address - Phone:585-591-6000
Practice Address - Fax:585-591-6962
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000809363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000809OtherLICENSE
R53942Medicare UPIN
PA0262Medicare ID - Type UnspecifiedMEDICARE