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General NPI Number Information
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NPI Number | 1639601982
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Entity Type | Organization
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Legal Business Name | JORDAN B KOSTERICH DC PLLC
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Dates
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Enumeration Date | 03/28/2017
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Last Update Date | 03/28/2017
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Provider Practice Location Address
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Address Line | 5 NORTH AVE
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City | NEW ROCHELLE
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State | NY
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Zip | 10805-3505
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Country | US
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Telephone | 914-636-4113
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Fax | 914-636-7839
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Provider Business Mailing Address
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Address Line | 5 NORTH AVE
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City | NEW ROCHELLE
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State | NY
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Zip | 10805-3505
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Country | US
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Telephone | 914-636-4113
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Fax | 914-636-7839
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. JORDAN BENJAMIN KOSTERICH
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Credential | D.C.
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Telephone | 914-636-4113
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | X012930
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License Number State | NY
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