Provider Demographics
NPI:1154895662
Name:JORDAN, JOSEPH PATRICK V
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:PATRICK
Last Name:JORDAN
Suffix:V
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 MARBLE LN
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19444-1312
Mailing Address - Country:US
Mailing Address - Phone:267-438-0678
Mailing Address - Fax:
Practice Address - Street 1:201 MARBLE LN
Practice Address - Street 2:
Practice Address - City:LAFAYETTE HILL
Practice Address - State:PA
Practice Address - Zip Code:19444-1312
Practice Address - Country:US
Practice Address - Phone:267-438-0678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-17
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program