Provider Demographics
NPI:1588651608
Name:JORDAN, LAWRENCE JOSEPH III (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:JOSEPH
Last Name:JORDAN
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 PLAINSBORO ROAD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:PLAINSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08536-1913
Mailing Address - Country:US
Mailing Address - Phone:609-936-9100
Mailing Address - Fax:609-936-9700
Practice Address - Street 1:5 PLAINSBORO ROAD
Practice Address - Street 2:SUITE 400
Practice Address - City:PLAINSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08536-1913
Practice Address - Country:US
Practice Address - Phone:609-936-9100
Practice Address - Fax:609-936-9700
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05103400174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2486504Medicaid
D19430Medicare UPIN
000568AEBMedicare PIN