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General NPI Number Information
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NPI Number | 1164450300
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Entity Type | Individual
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Provider Name | JORDAN S GITLIN MD
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Gender | Male
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Dates
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Enumeration Date | 06/28/2006
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Last Update Date | 07/30/2025
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Provider Practice Location Address
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Address Line | 247 ROUTE 100 SUITE 1002
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City | SOMERS
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State | NY
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Zip | 10589-3231
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Country | US
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Telephone | 914-962-8290
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Fax | 914-962-8851
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Provider Business Mailing Address
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Address Line | 1999 MARCUS AVE SUITE M18
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City | NEW HYDE PARK
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State | NY
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Zip | 11042-1017
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Country | US
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Telephone | 516-466-6953
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Fax | 516-466-5608
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2088P0231X
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Taxonomy Name | Pediatric Urology Physician
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License Number | ME170154
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 203315
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 2088P0231X
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Taxonomy Name | Pediatric Urology Physician
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License Number | 203315
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License Number State | NY
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