Provider Demographics
NPI:1154624641
Name:JORDAN, SUZANNE (DPT)
Entity type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:
Last Name:JORDAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 W 111TH ST
Mailing Address - Street 2:5W
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10026-4341
Mailing Address - Country:US
Mailing Address - Phone:917-539-4191
Mailing Address - Fax:
Practice Address - Street 1:115TH E 57TH ST
Practice Address - Street 2:#1460
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-2077
Practice Address - Country:US
Practice Address - Phone:212-486-0888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-06
Last Update Date:2010-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033287225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist