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General NPI Number Information
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NPI Number | 1316755358
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Entity Type | Individual
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Provider Name | JEANIQUE JORDAN
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Gender | Female
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Dates
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Enumeration Date | 12/23/2024
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Last Update Date | 12/23/2024
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Provider Practice Location Address
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Address Line | 27005 76TH AVE
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City | NEW HYDE PARK
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State | NY
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Zip | 11040-1402
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Country | US
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Telephone | 718-470-7310
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Fax |
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Provider Business Mailing Address
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Address Line | 12111 196TH ST # 2
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City | SPRINGFIELD GARDENS
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State | NY
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Zip | 11413-1138
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Country | US
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Telephone | 617-201-4696
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WE0003X
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Taxonomy Name | Emergency Registered Nurse
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License Number | 814550
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License Number State | NY
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