Provider Demographics
NPI:1164927893
Name:CIEPLY, JORDAN (DO)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:CIEPLY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:
Other - Last Name:SCOLARO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:99 EAST RIVER DRIVE
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06108-4292
Mailing Address - Country:US
Mailing Address - Phone:860-282-4128
Mailing Address - Fax:
Practice Address - Street 1:2800 MAIN ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-4292
Practice Address - Country:US
Practice Address - Phone:860-545-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-26
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CT69726207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program