National Provider Identifier

Jordan Healthcare Center

Jordan Healthcare Center is listed in the NPPES registry with a primary specialty of Clinic/Center in Rochester, NY and a listed phone number of (585) 254-6480.

NPI 1396197158Rochester, NYClinic/Center

Profile Overview

NPI
1396197158
Provider Type
Organization
Primary Specialty
Clinic/Center
Enumeration Date
July 05, 2016
Last Updated
July 05, 2016

Practice Location

  • 322 Lake Ave Ste 1
  • Rochester, NY 14608-1162

Phone: (585) 254-6480

Mailing Address

  • 817 Pond View Hts
  • Rochester, NY 14612-1350

Specialties

  • Clinic/Center (261Q00000X)
Full Record
NPI
1396197158
Entity Type
Organization
EIN
<UNAVAIL>
Organization Name
Jordan Healthcare Center
Mailing Street Address
817 Pond View Hts
Mailing City
Rochester
Mailing State
NY
Mailing ZIP Code
14612-1350
Mailing Country
US
Mailing Phone
(917) 716-5479
Practice Street Address
322 Lake Ave Ste 1
Practice City
Rochester
Practice State
NY
Practice ZIP Code
14608-1162
Practice Country
US
Practice Phone
(585) 254-6480
Enumeration Date
July 05, 2016
Last Updated
July 05, 2016
Authorized Official Last Name
Taub
Authorized Official First Name
Vladimir
Authorized Official Title
Nurse Practitioner
Authorized Official Phone
(917) 716-5479
Organization Subpart
No
Authorized Official Credential Text
FNP
updated_by_file
npidata_pfile_20050523-20260308.csv
Taxonomies
Clinic/Center (261Q00000X)