Healthcare Provider Details

I. General information

NPI: 1891063491
Provider Name (Legal Business Name): JORDAN D METZL MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2011
Last Update Date: 12/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

519 E 72ND ST RM 206
NEW YORK NY
10021-4028
US

IV. Provider business mailing address

535 E 70TH ST
NEW YORK NY
10021-4823
US

V. Phone/Fax

Practice location:
  • Phone: 212-606-1678
  • Fax:
Mailing address:
  • Phone: 212-606-1678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number210811
License Number StateNY

VIII. Authorized Official

Name: JORDAN D METZL
Title or Position: PRESIDENT
Credential: MD
Phone: 212-606-1678