Healthcare Provider Details

I. General information

NPI: 1215009345
Provider Name (Legal Business Name): J. JORDAN STORLAZZI JR., M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 07/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 SILVERSIDE RD SUITE 5
WILMINGTON DE
19810-3719
US

IV. Provider business mailing address

2700 SILVERSIDE RD SUITE 5
WILMINGTON DE
19810-3719
US

V. Phone/Fax

Practice location:
  • Phone: 302-478-1975
  • Fax: 302-478-9120
Mailing address:
  • Phone: 302-478-1975
  • Fax: 302-478-9120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC100000170
License Number StateDE

VIII. Authorized Official

Name: DR. JOSEPH JORDAN STORLAZZI JR.
Title or Position: PRESIDENT
Credential: M.D.
Phone: 302-479-5453