Provider Demographics
NPI:1811416886
Name:JORDAN, ERIN (APN)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:JORDAN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 E 66TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-6547
Mailing Address - Country:US
Mailing Address - Phone:646-498-9162
Mailing Address - Fax:
Practice Address - Street 1:40 BEY LEA RD
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-2989
Practice Address - Country:US
Practice Address - Phone:732-341-0720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-11
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF382772-1363LP0200X
NJ26NJ00766300363LP0200X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatrics