Healthcare Provider Details

I. General information

NPI: 1396197158
Provider Name (Legal Business Name): JORDAN HEALTHCARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2016
Last Update Date: 07/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

322 LAKE AVE STE 1
ROCHESTER NY
14608-1162
US

IV. Provider business mailing address

817 POND VIEW HTS
ROCHESTER NY
14612-1350
US

V. Phone/Fax

Practice location:
  • Phone: 585-254-6480
  • Fax:
Mailing address:
  • Phone: 917-716-5479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: VLADIMIR TAUB
Title or Position: NURSE PRACTITIONER
Credential: FNP
Phone: 917-716-5479