Provider Demographics
NPI:1619758968
Name:ANTHONY L. JORDAN HEALTH CORPORATION
Entity type:Organization
Organization Name:ANTHONY L. JORDAN HEALTH CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:585-423-2870
Mailing Address - Street 1:214C LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14608-1208
Mailing Address - Country:US
Mailing Address - Phone:585-784-5918
Mailing Address - Fax:
Practice Address - Street 1:82 HOLLAND ST STE 100
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14605-2131
Practice Address - Country:US
Practice Address - Phone:585-719-1932
Practice Address - Fax:585-719-1958
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANTHONY L. JORDAN HEALTH CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-10-12
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY040614OtherSTATE LICENSE