Provider Demographics
NPI:1821580739
Name:GOETHEL, JORDAN LEE (DO)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:LEE
Last Name:GOETHEL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:11 NEWCOMB DR
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12211-1809
Mailing Address - Country:US
Mailing Address - Phone:703-582-2534
Mailing Address - Fax:
Practice Address - Street 1:ANESTHESIA GROUP OF ALBANY PC
Practice Address - Street 2:1450 WESTERN AVENUE, SUITE 102
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-3539
Practice Address - Country:US
Practice Address - Phone:514-630-0050
Practice Address - Fax:518-207-2973
Is Sole Proprietor?:No
Enumeration Date:2018-06-06
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY316827207LA0401X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LA0401XAllopathic & Osteopathic PhysiciansAnesthesiologyAddiction Medicine