Healthcare Provider Details

I. General information

NPI: 1154327476
Provider Name (Legal Business Name): JORDAN MICHAEL CINER DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 09/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E 87TH ST APT 28AB
NEW YORK NY
10128-3203
US

IV. Provider business mailing address

201 EAST 87 STREET APT. 28AB
NEW YORK NY
10128
US

V. Phone/Fax

Practice location:
  • Phone: 212-289-8969
  • Fax: 212-289-6003
Mailing address:
  • Phone: 212-289-8969
  • Fax: 212-289-6003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberN005488
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: