Healthcare Provider Details

I. General information

NPI: 1033003975
Provider Name (Legal Business Name): JORDAN SAX
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2025
Last Update Date: 06/05/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 W 82ND ST # LLP101
NEW YORK NY
10024-5511
US

IV. Provider business mailing address

257 GOLD ST APT 5K
BROOKLYN NY
11201-2042
US

V. Phone/Fax

Practice location:
  • Phone: 646-389-4112
  • Fax:
Mailing address:
  • Phone: 720-401-5419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberP134928
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: