Healthcare Provider Details

I. General information

NPI: 1316349095
Provider Name (Legal Business Name): JPS MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2014
Last Update Date: 11/01/2024
Certification Date: 11/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 E 28TH ST APT 21D
NEW YORK NY
10016-7980
US

IV. Provider business mailing address

50 E 28TH ST APT 21D
NEW YORK NY
10016-7980
US

V. Phone/Fax

Practice location:
  • Phone: 646-239-8418
  • Fax:
Mailing address:
  • Phone: 646-239-8418
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number272774
License Number StateNY

VIII. Authorized Official

Name: DR. JORDAN SUDBERG
Title or Position: OWNER
Credential: MD
Phone: 646-239-8418