MEDICARE: ERIN JORDAN APN

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	363LP0200X	Pediatric Nurse Practitioner	F382772-1	NY
2	363LP0200X	Pediatric Nurse Practitioner	26NJ00766300	NJ
3	208000000X	Pediatrics Physician	26NJ00766300	NJ

General Provider Information

NPI Number	:	1811416886
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIN JORDAN APN

Provider Business Mailing Address
First Line	:	116 E 66TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10065-6547
Country	:	US
Telephone Number	:	646-498-9162
Fax Number	:

Provider Business Practice Location Address
First Line	:	40 BEY LEA RD
Second Line	:
City	:	TOMS RIVER
State	:	NJ
Zip	:	08753-2989
Country	:	US
Telephone Number	:	732-341-0720
Fax Number	:

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

Provider Enumeration Date	:	09/11/2017
Last Update Date	:	11/22/2024

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