Provider Demographics
NPI:1063094688
Name:JESSICA KURZDORFER NURSE PRACTITIONER IN PSYCHIATRY PC
Entity type:Organization
Organization Name:JESSICA KURZDORFER NURSE PRACTITIONER IN PSYCHIATRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KURZDORFER
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:585-360-7554
Mailing Address - Street 1:59 ROWLEY ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14607-2630
Mailing Address - Country:US
Mailing Address - Phone:585-360-7554
Mailing Address - Fax:949-577-4708
Practice Address - Street 1:95 ALLENS CREEK RD STE 330
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-3246
Practice Address - Country:US
Practice Address - Phone:585-360-7554
Practice Address - Fax:949-577-4708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-23
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health