Provider Demographics
NPI:1154385920
Name:PRITZKER, JORDAN G (MD)
Entity type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:G
Last Name:PRITZKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:175 COMMUNITY DR
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5502
Mailing Address - Country:US
Mailing Address - Phone:516-465-1900
Mailing Address - Fax:516-465-1830
Practice Address - Street 1:1554 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-3006
Practice Address - Country:US
Practice Address - Phone:516-390-9242
Practice Address - Fax:516-390-9251
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY173256207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01585015Medicaid
NY62F241Medicare ID - Type Unspecified
E62765Medicare UPIN
NY01585015Medicaid