Healthcare Provider Details

I. General information

NPI: 1922752005
Provider Name (Legal Business Name): JORDAN STEINBERG D.P.M. LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2022
Last Update Date: 11/18/2022
Certification Date: 11/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 MILLBURN AVE
MILLBURN NJ
07041-1719
US

IV. Provider business mailing address

227 MILLBURN AVE
MILLBURN NJ
07041-1719
US

V. Phone/Fax

Practice location:
  • Phone: 973-762-9294
  • Fax: 973-762-9262
Mailing address:
  • Phone: 973-762-9294
  • Fax: 973-762-9262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TARAMICHELLE CRAFT
Title or Position: CREDENTIALING CLERK
Credential:
Phone: 228-366-4335