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General NPI Number Information
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NPI Number | 1497397947
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Entity Type | Individual
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Provider Name | JORDAN NISSINOFF OD
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Gender | Male
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Dates
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Enumeration Date | 10/16/2019
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Last Update Date | 08/10/2023
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Provider Practice Location Address
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Address Line | 112 EISENHOWER PKWY STE 44
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City | LIVINGSTON
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State | NJ
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Zip | 07039-4900
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Country | US
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Telephone | 973-535-3344
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Fax |
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Provider Business Mailing Address
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Address Line | 2 12TH ST APT PH07
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City | HOBOKEN
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State | NJ
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Zip | 07030-6785
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Country | US
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Telephone | 321-537-9976
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 27OA00692800
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License Number State | NJ
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