National Provider Identifier

Anthony L. Jordan Health Corporation

Anthony L. Jordan Health Corporation is listed in the NPPES registry with a primary specialty of Federally Qualified Health Center (FQHC) in Rochester, NY and a listed phone number of (585) 697-7120.

NPI 1609141316Rochester, NYFederally Qualified Health Center (FQHC)

Profile Overview

NPI
1609141316
Provider Type
Organization
Primary Specialty
Federally Qualified Health Center (FQHC)
Enumeration Date
March 13, 2012
Last Updated
February 20, 2014

Practice Location

  • 666 Plymouth Ave S
  • Rochester, NY 14608-2766

Phone: (585) 697-7120

Mailing Address

  • 82 Holland St
  • Rochester, NY 14605-2131

Specialties

  • Federally Qualified Health Center (FQHC) (261QF0400X)
Full Record
NPI
1609141316
Entity Type
Organization
EIN
<UNAVAIL>
Organization Name
Anthony L. Jordan Health Corporation
Other Organization Name
<Unavail>
Provider Other Organization Name Type Code
6
Mailing Street Address
82 Holland St
Mailing City
Rochester
Mailing State
NY
Mailing ZIP Code
14605-2131
Mailing Country
US
Mailing Phone
(585) 423-5800
Mailing Fax
(585) 423-2806
Practice Street Address
666 Plymouth Ave S
Practice City
Rochester
Practice State
NY
Practice ZIP Code
14608-2766
Practice Country
US
Practice Phone
(585) 697-7120
Practice Fax
(585) 697-7121
Enumeration Date
March 13, 2012
Last Updated
February 20, 2014
Authorized Official Last Name
Harbin
Authorized Official First Name
Janice
Authorized Official Title
President/CEO
Authorized Official Phone
(585) 423-2878
Organization Subpart
Yes
Parent Organization Name
ANTHONY L. JORDAN HEALTH CORPORATION
Parent Organization TIN
<UNAVAIL>
Authorized Official Credential Text
DDS
updated_by_file
npidata_pfile_20050523-20260308.csv
Taxonomies
Federally Qualified Health Center (FQHC) (261QF0400X)
Other Identifiers
00384969 (NY), 16467A (NY, Medicare Part B), G0187295590 (NY, Blue Choice Of Rochester), 331838 (NY, Medicare Part A), 6613 (NY, Blue Cross Of Rochester)