Provider Demographics
NPI:1033193362
Name:JORDAN, ROBERT PAUL (DPM)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:PAUL
Last Name:JORDAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:DR
Other - First Name:R.
Other - Middle Name:PAUL
Other - Last Name:JORDAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:19 FOX HOLLOW RIDINGS RD
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11768-2244
Mailing Address - Country:US
Mailing Address - Phone:631-754-3261
Mailing Address - Fax:
Practice Address - Street 1:1023 PULASKI RD
Practice Address - Street 2:
Practice Address - City:E NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11731-1931
Practice Address - Country:US
Practice Address - Phone:631-754-3261
Practice Address - Fax:631-754-3767
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY002856213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery