Provider Demographics
NPI:1093205148
Name:CHALOUPKA, JORDAN MARIE (RN)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:MARIE
Last Name:CHALOUPKA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4212 LUDWIG LN
Mailing Address - Street 2:
Mailing Address - City:BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11714-6223
Mailing Address - Country:US
Mailing Address - Phone:516-815-3385
Mailing Address - Fax:
Practice Address - Street 1:4212 LUDWIG LN
Practice Address - Street 2:
Practice Address - City:BETHPAGE
Practice Address - State:NY
Practice Address - Zip Code:11714-6223
Practice Address - Country:US
Practice Address - Phone:516-815-3385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-15
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY723582-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse