MEDICARE: DR. JORDAN CHRISTOPHER IORDANOU MD/PHD

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	207T00000X	Neurological Surgery Physician	V0766	TX
2	390200000X	Student in an Organized Health Care Education/Training Program	125073300	IL
3	207T00000X	Neurological Surgery Physician	289788	NY

General Provider Information

NPI Number	:	1396107710
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JORDAN CHRISTOPHER IORDANOU MD/PHD

Provider Business Mailing Address
First Line	:	110 E MAIN ST
Second Line	:
City	:	HUNTINGTON
State	:	NY
Zip	:	11743-2845
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	110 E MAIN ST
Second Line	:
City	:	HUNTINGTON
State	:	NY
Zip	:	11743-2845
Country	:	US
Telephone Number	:	631-802-6469
Fax Number	:

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

Provider Enumeration Date	:	03/24/2016
Last Update Date	:	08/18/2025

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