Provider Demographics
NPI:1194070516
Name:JORDAN, MATTHEW JOHN (PA)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:JOHN
Last Name:JORDAN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:7819 18TH AVE STE A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-1729
Mailing Address - Country:US
Mailing Address - Phone:718-236-0700
Mailing Address - Fax:718-232-2625
Practice Address - Street 1:7819 18TH AVE STE A
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-1729
Practice Address - Country:US
Practice Address - Phone:718-236-0700
Practice Address - Fax:718-232-2625
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-23
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY015551363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant