| Doctor Name: | ROBERT PAUL JORDAN |
| NPI Number: | 1033193362 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | D.P.M. |
| License Number: | NY002856 |
| Business Practice Address: | 1023 Pulaski Rd E Northport, NY - 117311931 |
| Business Phone Number: | 6317543261 |
| Business Fax Number: | 6317543767 |
| Mailing Address: | 19 Fox Hollow Ridings Rd, NORTHPORT |
| State: | NY |
| Postal Code: | 117682244 |
| Phone Number: | 6317543261 |
| Fax Number: | |
| NPI Enumeration Date: | 11/30/2005 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213ES0131X |
| License Number: | NY002856 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Foot Surgery |
| Taxonomy Definition: | |