Basic Information
| Provider Information | |||||||||
| NPI: | 1669032066 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SAMUEL | ||||||||
| FirstName: | JORDAN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 817 FENIMORE RD | ||||||||
| Address2: | |||||||||
| City: | MAMARONECK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105432102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9147140685 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1250 WATERS PLACE | ||||||||
| Address2: | TOWER 1, SUITE 501 | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10461 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184099444 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2019 | ||||||||
| LastUpdateDate: | 06/18/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.