Healthcare Provider Details

I. General information

NPI: 1144066994
Provider Name (Legal Business Name): JORDAN LYNN INDYK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2024
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 MAYOR GIBSON BLVD STE 606
NEWARK NJ
07102-4537
US

IV. Provider business mailing address

48 SEYMOUR AVE
WOODBRIDGE NJ
07095-2407
US

V. Phone/Fax

Practice location:
  • Phone: 201-822-1161
  • Fax:
Mailing address:
  • Phone: 908-698-3574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SL06745100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: