Healthcare Provider Details

I. General information

NPI: 1821931908
Provider Name (Legal Business Name): DWAYNE JORDAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2026
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1237 E 83RD ST
BROOKLYN NY
11236-4932
US

IV. Provider business mailing address

1237 E 83RD ST
BROOKLYN NY
11236-4932
US

V. Phone/Fax

Practice location:
  • Phone: 973-715-0135
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number992397
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number992397
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: