Provider Demographics
NPI:1093970147
Name:JORDAN GARRISON MD
Entity Type:Organization
Organization Name:JORDAN GARRISON MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PWNER
Authorized Official - Prefix:
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-437-8021
Mailing Address - Street 1:147 COLUMBIA TPKE
Mailing Address - Street 2:STE 308
Mailing Address - City:FLORHAM PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07932-2113
Mailing Address - Country:US
Mailing Address - Phone:973-437-8021
Mailing Address - Fax:973-410-0057
Practice Address - Street 1:147 COLUMBIA TPKE
Practice Address - Street 2:STE 308
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932-2113
Practice Address - Country:US
Practice Address - Phone:973-437-8021
Practice Address - Fax:973-410-0057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-28
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04279600174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJGA610838Medicare UPIN