Provider Demographics
NPI:1215009345
Name:J. JORDAN STORLAZZI JR., M.D., P.A.
Entity Type:Organization
Organization Name:J. JORDAN STORLAZZI JR., M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:JORDAN
Authorized Official - Last Name:STORLAZZI
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:302-479-5453
Mailing Address - Street 1:2700 SILVERSIDE RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-3719
Mailing Address - Country:US
Mailing Address - Phone:302-478-1975
Mailing Address - Fax:302-478-9120
Practice Address - Street 1:2700 SILVERSIDE RD
Practice Address - Street 2:SUITE 5
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-3719
Practice Address - Country:US
Practice Address - Phone:302-478-1975
Practice Address - Fax:302-478-9120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2017-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC100000170208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000059201Medicaid
DEB66429Medicare UPIN
DE0000059201Medicaid