Provider Demographics
NPI:1649230251
Name:JORDAN, BARRY D (MD)
Entity type:Individual
Prefix:DR
First Name:BARRY
Middle Name:D
Last Name:JORDAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:195 BALCOM AVE
Mailing Address - Street 2:# 3A
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465-0362
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:785 MAMARONECK AVE
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-2523
Practice Address - Country:US
Practice Address - Phone:914-597-2500
Practice Address - Fax:914-597-2439
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY150448204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY150448OtherSTATE LICENSE
NY24E302Medicare ID - Type Unspecified
NY150448OtherSTATE LICENSE