Provider Demographics
NPI:1043307051
Name:JORDAN, DANIEL ROBERT (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:ROBERT
Last Name:JORDAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 SUNSET RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BURLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08016-3645
Mailing Address - Country:US
Mailing Address - Phone:609-387-9242
Mailing Address - Fax:609-387-1948
Practice Address - Street 1:811 SUNSET RD
Practice Address - Street 2:SUITE 101
Practice Address - City:BURLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08016-3645
Practice Address - Country:US
Practice Address - Phone:609-387-9242
Practice Address - Fax:609-387-1948
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07115000207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0807554000OtherAMERIHEALTH, KEYSTONE, IBC
1124862OtherHORIZON NJ HEALTH
2464681OtherAETNA
NJ8351902Medicaid
0807554000OtherAMERIHEALTH, KEYSTONE, IBC
NJ8351902Medicaid