1740356286 NPI number — DR. WILLY JP JORDONNE DDS

Table of content: DR. WILLY JP JORDONNE DDS (NPI 1740356286)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740356286 NPI number — DR. WILLY JP JORDONNE DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JORDONNE
Provider First Name:
WILLY
Provider Middle Name:
JP
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740356286
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1177 NOSTRAND AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11225-5911
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-953-1043
Provider Business Mailing Address Fax Number:
718-953-3550

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
72 BORGLUM RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANHASSET
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11030-2123
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-365-5561
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  040640 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01005774 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com