Provider Demographics
NPI:1598590994
Name:JOURDENWELL AESTHETICS
Entity type:Organization
Organization Name:JOURDENWELL AESTHETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OF DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:HO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:718-866-0022
Mailing Address - Street 1:13682 39TH AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-5524
Mailing Address - Country:US
Mailing Address - Phone:718-866-0022
Mailing Address - Fax:
Practice Address - Street 1:13682 39TH AVE FL 1
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5524
Practice Address - Country:US
Practice Address - Phone:718-866-0022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty