Individual
JORDAN PEIXOTO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
445 MEADOW RD, KINGS PARK, NY 11754-5007
(631) 827-1948
Mailing address
445 MEADOW RD, KINGS PARK, NY 11754-5007
(631) 827-1948
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
04/26/2016
Last updated
04/26/2016
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