MEDICARE: JORDAN MARIE HENRY PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	25MP00888300	NJ

General Provider Information

NPI Number	:	1023838562
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN MARIE HENRY PA-C

Provider Business Mailing Address
First Line	:	415 NEW RD STE 3
Second Line	:
City	:	SOMERS POINT
State	:	NJ
Zip	:	08244-2106
Country	:	US
Telephone Number	:	201-227-1299
Fax Number	:	609-846-4040

Provider Business Practice Location Address
First Line	:	415 NEW RD STE 3
Second Line	:
City	:	SOMERS POINT
State	:	NJ
Zip	:	08244-2106
Country	:	US
Telephone Number	:	201-227-1299
Fax Number	:	609-846-4040

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2024
Last Update Date	:	02/03/2026

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