Basic Information
| Provider Information | |||||||||
| NPI: | 1871875849 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DE LA GARZA-JORDAN | ||||||||
| FirstName: | JULIA | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 19 BRADHURST AVE | ||||||||
| Address2: | SUITE 3100N | ||||||||
| City: | HAWTHORNE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105322140 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9149099018 | ||||||||
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| Practice Location | |||||||||
| Address1: | 100 WOODS RD | ||||||||
| Address2: | TAYLOR PAVILION RM D368 | ||||||||
| City: | VALHALLA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105951530 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9144937530 | ||||||||
| FaxNumber: | 9144935827 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2011 | ||||||||
| LastUpdateDate: | 04/25/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZF0201X | 242081 | NY | N | Allopathic & Osteopathic Physicians | Pathology | Forensic Pathology | 207ZP0101X | 242081 | NY | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology |
No ID Information.