Provider Demographics
NPI:1235548199
Name:JORDAN-JOSEPH, DAPHNE (CDN)
Entity Type:Individual
Prefix:MRS
First Name:DAPHNE
Middle Name:
Last Name:JORDAN-JOSEPH
Suffix:
Gender:F
Credentials:CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:363 ELTON STREET
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11208
Mailing Address - Country:US
Mailing Address - Phone:347-788-7350
Mailing Address - Fax:
Practice Address - Street 1:271 NORTH AVE
Practice Address - Street 2:SUITE 111 ULTIMATE CONSULTATION
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801
Practice Address - Country:US
Practice Address - Phone:914-235-3674
Practice Address - Fax:914-633-1584
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-05
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY133N00000X133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist