Provider Demographics
NPI:1942452461
Name:JORDAN GARRISON MD LLC
Entity Type:Organization
Organization Name:JORDAN GARRISON MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:GARRISON
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:973-759-8700
Mailing Address - Street 1:PO BOX 640
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-0640
Mailing Address - Country:US
Mailing Address - Phone:973-759-8700
Mailing Address - Fax:973-759-7545
Practice Address - Street 1:147 COLUMBIA TPKE
Practice Address - Street 2:STE 308
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932-2113
Practice Address - Country:US
Practice Address - Phone:973-437-8021
Practice Address - Fax:973-410-0057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-15
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty