Healthcare Provider Details

I. General information

NPI: 1083716088
Provider Name (Legal Business Name): ANTHONY L. JORDAN HEALTH CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

82 HOLLAND STREET
ROCHESTER NY
14605-2131
US

IV. Provider business mailing address

82 HOLLAND STREET C/O HR CREDENTING DEPT.
ROCHESTER NY
14605-2131
US

V. Phone/Fax

Practice location:
  • Phone: 585-423-5800
  • Fax: 585-423-2890
Mailing address:
  • Phone: 585-423-2816
  • Fax: 585-423-2853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number2701211R
License Number StateNY

VIII. Authorized Official

Name: MONICA GRAHAM
Title or Position: HR CREDENTILAING SPECIALIST
Credential:
Phone: 585-423-2816