Provider Demographics
NPI:1205116191
Name:BARNARD, JORDAN DAVID
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:DAVID
Last Name:BARNARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 SHERMAN HILL RD APT A12
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06798-3664
Mailing Address - Country:US
Mailing Address - Phone:203-263-2162
Mailing Address - Fax:
Practice Address - Street 1:126 SHERMAN HILL RD APT A12
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:CT
Practice Address - Zip Code:06798-3664
Practice Address - Country:US
Practice Address - Phone:203-263-2162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-23
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program