Provider Demographics
NPI:1922752005
Name:JORDAN STEINBERG D.P.M. LLC
Entity Type:Organization
Organization Name:JORDAN STEINBERG D.P.M. LLC
Other - Org Name:THE PODIATRY CENTER PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING CLERK
Authorized Official - Prefix:
Authorized Official - First Name:TARAMICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAFT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:228-366-4335
Mailing Address - Street 1:227 MILLBURN AVE
Mailing Address - Street 2:
Mailing Address - City:MILLBURN
Mailing Address - State:NJ
Mailing Address - Zip Code:07041-1719
Mailing Address - Country:US
Mailing Address - Phone:973-762-9294
Mailing Address - Fax:973-762-9262
Practice Address - Street 1:227 MILLBURN AVE
Practice Address - Street 2:
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041-1719
Practice Address - Country:US
Practice Address - Phone:973-762-9294
Practice Address - Fax:973-762-9262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-08
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatricGroup - Single Specialty