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General NPI Number Information
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NPI Number | 1639353444
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Entity Type | Organization
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Legal Business Name | JORDAN KLESMER MD PLLC
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Dates
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Enumeration Date | 12/28/2007
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Last Update Date | 03/30/2017
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Provider Practice Location Address
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Address Line | 1 BARSTOW RD SUITE P24
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City | GREAT NECK
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State | NY
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Zip | 11021-3501
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Country | US
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Telephone | 917-584-5043
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Fax |
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Provider Business Mailing Address
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Address Line | 1 BARSTOW RD SUITE P24
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City | GREAT NECK
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State | NY
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Zip | 11021-3501
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Country | US
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Telephone | 917-584-5043
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. JORDAN KLESMER
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Credential | MD
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Telephone | 917-584-5043
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 170536
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License Number State | NY
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