Basic Information
| Provider Information | |||||||||
| NPI: | 1679531289 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FORD | ||||||||
| FirstName: | JOCKULAR | ||||||||
| MiddleName: | BRADY | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 711 TROY SCHENECTADY RD | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | LATHAM | ||||||||
| State: | NY | ||||||||
| PostalCode: | 121102442 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5187823700 | ||||||||
| FaxNumber: | 5187823799 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 JORDAN RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | TROY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 121808343 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5182740476 | ||||||||
| FaxNumber: | 5182740497 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2006 | ||||||||
| LastUpdateDate: | 08/16/2013 | ||||||||
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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 | 207V00000X | 127727 | NY | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 0005367485 | 01 | NY | AETNA | OTHER | 00040400801 | 01 | NY | UNIVERA | OTHER | 141655014 | 01 | NY | UNITED HEALTHCARE | OTHER | 040426006337 | 01 | NY | FIDELIS | OTHER | 10000669 | 01 | NY | CDPHP | OTHER | 45520 | 01 | NY | GHIHMO | OTHER | 00298971 | 05 | NY | MEDICAID | 160011356 | 01 | NY | RAILROAD MEDICARE | OTHER | 110129 | 01 | NY | WELLCARE | OTHER | 16151 | 01 | NY | MVP | OTHER | 000416095001 | 01 | NY | BLUE SHIELD | OTHER | 0015055 | 01 | NY | GHI | OTHER | 141655014 | 01 | NY | EMPIRE PLAN | OTHER | 50Z111 | 01 | NY | BLUE CROSS | OTHER |