Provider Demographics
NPI:1154327476
Name:CINER, JORDAN MICHAEL (DPM)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:MICHAEL
Last Name:CINER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 EAST 87 STREET APT. 28AB
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128
Mailing Address - Country:US
Mailing Address - Phone:212-289-8969
Mailing Address - Fax:212-289-6003
Practice Address - Street 1:201 E 87TH ST APT 28AB
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-3203
Practice Address - Country:US
Practice Address - Phone:212-289-8969
Practice Address - Fax:212-289-6003
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005488213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01995495Medicaid
NY03743OtherGHI MEDICARE
480031685OtherRAILROAD MEDICARE
PB0631OtherEMPIRE MEDICARE
480031685OtherRAILROAD MEDICARE
U75479Medicare UPIN