Provider Demographics
NPI:1285033662
Name:JORDAN SUDBERG MD P.C.
Entity Type:Organization
Organization Name:JORDAN SUDBERG MD P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SUDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-239-8418
Mailing Address - Street 1:1 UNIVERSITY PL
Mailing Address - Street 2:APARTMENT 7L
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-4516
Mailing Address - Country:US
Mailing Address - Phone:646-239-8418
Mailing Address - Fax:
Practice Address - Street 1:2805 VETERANS MEMORIAL HWY
Practice Address - Street 2:SUITE 8
Practice Address - City:RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-7647
Practice Address - Country:US
Practice Address - Phone:646-239-8418
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-21
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2727742081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty