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General NPI Number Information
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NPI Number | 1497831424
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Entity Type | Individual
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Provider Name | SALLY C JORDAN M.D.
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Gender | Female
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Dates
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Enumeration Date | 10/31/2006
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Last Update Date | 10/22/2018
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Provider Practice Location Address
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Address Line | 955 YONKERS AVE STE 100
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City | YONKERS
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State | NY
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Zip | 10704-3062
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Country | US
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Telephone | 914-472-5140
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Fax | 914-473-5270
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Provider Business Mailing Address
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Address Line | 955 YONKERS AVENUE BOX 21
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City | YONKERS
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State | NY
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Zip | 10704
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Country | US
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Telephone | 914-472-5140
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Fax | 914-472-5270
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 154001-1
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License Number State | NY
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