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General NPI Number Information
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NPI Number | 1568985521
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Entity Type | Individual
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Provider Name | JORDYN DIANE THIEM PA
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Gender | Female
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Dates
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Enumeration Date | 07/21/2017
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Last Update Date | 07/21/2017
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Provider Practice Location Address
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Address Line | 600 NORTHERN BLVD
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City | ALBANY
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State | NY
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Zip | 12204-1004
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Country | US
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Telephone | 978-790-7381
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Fax |
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Provider Business Mailing Address
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Address Line | 100 WATERS VIEW CIR APT 29-203
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City | COHOES
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State | NY
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Zip | 12047-5200
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Country | US
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Telephone | 978-790-7381
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Fax |
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 021086
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 021086
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License Number State | NY
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