Healthcare Provider Details

I. General information

NPI: 1104985183
Provider Name (Legal Business Name): J. JORDAN STORLAZZI JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 07/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 SILVERSIDE RD
WILMINGTON DE
19810-3719
US

IV. Provider business mailing address

2700 SILVERSIDE RD
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 Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License NumberC1-0000170
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: