Provider Demographics
NPI:1083085195
Name:JORDAN STEINBERG D.P.M. LLC
Entity Type:Organization
Organization Name:JORDAN STEINBERG D.P.M. LLC
Other - Org Name:FLORHAM PARK PODIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING CLERK
Authorized Official - Prefix:
Authorized Official - First Name:TARAMICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAFT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:228-366-4335
Mailing Address - Street 1:227 MILLBURN AVE
Mailing Address - Street 2:
Mailing Address - City:MILLBURN
Mailing Address - State:NJ
Mailing Address - Zip Code:07041
Mailing Address - Country:US
Mailing Address - Phone:228-366-4335
Mailing Address - Fax:866-716-1197
Practice Address - Street 1:83 HANOVER RD
Practice Address - Street 2:SUITE 160
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932-1508
Practice Address - Country:US
Practice Address - Phone:973-922-0464
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JORDAN STEINBERG, DPM, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-10-15
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
213E00000X
NJ25MD00322300213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty