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NPI Code Detail

MEDICARE: JORDAN IAN GAELEN

MEDICARE: JORDAN IAN GAELEN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1861161994
Entity Type Code : Individual
Provider Name (Legal Business Name) : JORDAN IAN GAELEN
Provider Business Mailing Address
First Line : 1 GUSTAVE L LEVY PL # 1010
Second Line :
City : NEW YORK
State : NY
Zip : 10029-6504
Country : US
Telephone Number : 212-241-1518
Fax Number :
Provider Business Practice Location Address
First Line : 1 GUSTAVE L LEVY PL # 1010
Second Line :
City : NEW YORK
State : NY
Zip : 10029-6504
Country : US
Telephone Number : 212-241-1518
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/11/2021
Last Update Date : 04/06/2026

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Directions to “ JORDAN IAN GAELEN ” Practice Location

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