Provider Demographics
NPI:1104985183
Name:STORLAZZI, J. JORDAN JR (MD)
Entity type:Individual
Prefix:
First Name:J.
Middle Name:JORDAN
Last Name:STORLAZZI
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 SILVERSIDE RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-3719
Mailing Address - Country:US
Mailing Address - Phone:302-478-1975
Mailing Address - Fax:302-478-9120
Practice Address - Street 1:2700 SILVERSIDE RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-3719
Practice Address - Country:US
Practice Address - Phone:302-478-1975
Practice Address - Fax:302-478-9120
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2017-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-00001702080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000059201Medicaid
DEB66429Medicare UPIN
DE099796Medicare PIN