Provider Demographics
NPI:1265437891
Name:SCHWARTZBERG, JORDAN BLAKE (MD)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:BLAKE
Last Name:SCHWARTZBERG
Suffix:
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 1:7740 BOYNTON BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-3804
Mailing Address - Country:US
Mailing Address - Phone:561-752-8000
Mailing Address - Fax:561-752-8001
Practice Address - Street 1:9325 GLADES RD
Practice Address - Street 2:SUITE 207
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-3988
Practice Address - Country:US
Practice Address - Phone:561-487-7575
Practice Address - Fax:561-487-7576
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME83158207ND0101X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL43286YOtherMEDICARE ID
FLI08257Medicare UPIN