Basic Information
| Provider Information | |||||||||
| NPI: | 1962575753 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JORDAN | ||||||||
| FirstName: | MIRLANDE | ||||||||
| MiddleName: | P. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 893 WURTSBORO MOUNTAIN RD | ||||||||
| Address2: | |||||||||
| City: | WURTSBORO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 127902108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8458888095 | ||||||||
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| Practice Location | |||||||||
| Address1: | 43 ASHLEY AVE | ||||||||
| Address2: | BUILDING 57 | ||||||||
| City: | MIDDLETOWN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10940 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453436686 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/17/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 2084P0800X | 204760 | NY | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.