Provider Demographics
NPI:1265130058
Name:JORDAN B SMITH M D P C
Entity type:Organization
Organization Name:JORDAN B SMITH M D P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-573-2127
Mailing Address - Street 1:295 MADISON AVE STE 425
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-6434
Mailing Address - Country:US
Mailing Address - Phone:212-682-6620
Mailing Address - Fax:212-682-6588
Practice Address - Street 1:295 MADISON AVE STE 425
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-6434
Practice Address - Country:US
Practice Address - Phone:212-682-6620
Practice Address - Fax:212-682-6588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-21
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty