Provider Demographics
NPI:1326185216
Name:JORDAN, ANTHONY SALVATORE (PT)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:SALVATORE
Last Name:JORDAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:486 SCHOOLEY'S MOUNTAIN ROAD
Mailing Address - Street 2:BLDG. 2A, SUITE 1
Mailing Address - City:HACKETTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07840
Mailing Address - Country:US
Mailing Address - Phone:908-852-7002
Mailing Address - Fax:908-852-3976
Practice Address - Street 1:486 SCHOOLEY'S MOUNTAIN ROAD
Practice Address - Street 2:BLDG. 2A, SUITE 1
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840
Practice Address - Country:US
Practice Address - Phone:908-852-7002
Practice Address - Fax:908-852-3976
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00449900174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ655435Medicare PIN