Provider Demographics
NPI:1548753114
Name:CORDERO, JESSE A
Entity Type:Individual
Prefix:MR
First Name:JESSE
Middle Name:A
Last Name:CORDERO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3635 JOHNSON AVE APT 6F
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-1627
Mailing Address - Country:US
Mailing Address - Phone:134-760-2175
Mailing Address - Fax:
Practice Address - Street 1:61 MITCHELL PL
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-4343
Practice Address - Country:US
Practice Address - Phone:914-428-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-08
Last Update Date:2018-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101791-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker