MEDICARE: JORDAN ELIZABETH PEAKE

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	25MP00970000	NJ

General Provider Information

NPI Number	:	1073372587
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN ELIZABETH PEAKE

Provider Business Mailing Address
First Line	:	331 NEWMAN SPRINGS RD STE 220
Second Line	:
City	:	RED BANK
State	:	NJ
Zip	:	07701-5792
Country	:	US
Telephone Number	:	732-807-0877
Fax Number	:	201-751-1680

Provider Business Practice Location Address
First Line	:	1945 STATE ROUTE 33
Second Line	:
City	:	NEPTUNE
State	:	NJ
Zip	:	07753-4859
Country	:	US
Telephone Number	:	732-776-3790
Fax Number	:	732-776-4525

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

Provider Enumeration Date	:	03/18/2024
Last Update Date	:	12/26/2025

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