Provider Demographics
NPI:1558326330
Name:JORDAN, BEVERLY (MD, FAAP)
Entity Type:Individual
Prefix:DR
First Name:BEVERLY
Middle Name:
Last Name:JORDAN
Suffix:
Gender:F
Credentials:MD, FAAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:760 BROADWAY
Mailing Address - Street 2:WOODHULL HOSPITAL DEPARTMENT OF PEDIATRICS
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11206-5317
Mailing Address - Country:US
Mailing Address - Phone:718-963-7956
Mailing Address - Fax:718-963-7957
Practice Address - Street 1:760 BROADWAY
Practice Address - Street 2:WOODHULL HOSPITAL DEPARTMENT OF PEDIATRICS
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-5317
Practice Address - Country:US
Practice Address - Phone:718-963-7956
Practice Address - Fax:718-963-7957
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-18
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA054577208000000X
NY281964208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY301530833Medicaid