Organization
ANTHONY L. JORDAN HEALTH CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MONICA GRAHAM (HR CREDENTILAING SPECIALIST)
(585) 423-2816
Entity
Organization
Contact information
Practice address
82 HOLLAND STREET, ROCHESTER, NY 14605-2131
(585) 423-5800
(585) 423-2890
Mailing address
82 HOLLAND STREET, C/O HR CREDENTING DEPT., ROCHESTER, NY 14605-2131
(585) 423-2816
(585) 423-2853
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
2701211R
NY
261QF0400X
Federally Qualified Health Center (FQHC)
—
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00384969
—
NY
01
—
16467A
MEDICARE PART B
NY
01
—
331838
MEDICARE PART A
NY
01
—
6613
BLUE CROSS OF ROCHESTER
NY
01
—
G0187295590
BLUE CHOICE OF ROCHESTER
NY
Enumeration date
09/01/2006
Last updated
02/04/2025
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