1760691257 NPI number — DR. KAREN TEREZ JORDAN M.D., PH.D.

Table of content: DR. KAREN TEREZ JORDAN M.D., PH.D. (NPI 1760691257)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760691257 NPI number — DR. KAREN TEREZ JORDAN M.D., PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JORDAN
Provider First Name:
KAREN
Provider Middle Name:
TEREZ
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D., PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760691257
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/19/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 1584
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNT LAUREL
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08054-4840
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-309-1363
Provider Business Mailing Address Fax Number:
856-309-1369

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 WHITE HORSE ROAD
Provider Second Line Business Practice Location Address:
SUITE 902 GLENDALE EXECUTIVE CAMPUS
Provider Business Practice Location Address City Name:
VOORHEES
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08043-4415
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-309-1363
Provider Business Practice Location Address Fax Number:
856-309-1369
Provider Enumeration Date:
05/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  25MA05031400 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2084P0800X , with the licence number: MD039046E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 25MA05031400 . This is a "MEDICAL LICENSE NUMBER" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 5398509 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: MD039046E . This is a "MEDICAL LICENSE NUMBER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 01116898334678 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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