Provider Demographics
NPI:1760691257
Name:JORDAN, KAREN TEREZ (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:TEREZ
Last Name:JORDAN
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 1584
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-4840
Mailing Address - Country:US
Mailing Address - Phone:856-309-1363
Mailing Address - Fax:856-309-1369
Practice Address - Street 1:1000 WHITE HORSE ROAD
Practice Address - Street 2:SUITE 902 GLENDALE EXECUTIVE CAMPUS
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-4415
Practice Address - Country:US
Practice Address - Phone:856-309-1363
Practice Address - Fax:856-309-1369
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2009-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA050314002084P0800X
PAMD039046E2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MA05031400OtherMEDICAL LICENSE NUMBER
NJ5398509Medicaid
PAMD039046EOtherMEDICAL LICENSE NUMBER
NJ01116898334678Medicaid
PAE64134Medicare UPIN
NJ038662Medicare ID - Type Unspecified
NJ01116898334678Medicaid