Provider Demographics
NPI:1063534907
Name:SALLY C JORDAN, MD
Entity type:Organization
Organization Name:SALLY C JORDAN, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLLING MANGER
Authorized Official - Prefix:MS
Authorized Official - First Name:COUMBA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-588-9862
Mailing Address - Street 1:700 POST RD
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-5063
Mailing Address - Country:US
Mailing Address - Phone:914-472-5141
Mailing Address - Fax:845-207-9378
Practice Address - Street 1:700 POST RD
Practice Address - Street 2:
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-5063
Practice Address - Country:US
Practice Address - Phone:914-472-5141
Practice Address - Fax:845-207-9378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY154001-1OtherLICENSE