Provider Demographics
NPI:1427932052
Name:SU, JORDAN CJ (LIA)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:CJ
Last Name:SU
Suffix:
Gender:F
Credentials:LIA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 NORMANSKILL BLVD STE 204
Mailing Address - Street 2:
Mailing Address - City:DELMAR
Mailing Address - State:NY
Mailing Address - Zip Code:12054-1331
Mailing Address - Country:US
Mailing Address - Phone:518-364-5934
Mailing Address - Fax:
Practice Address - Street 1:2 NORMANSKILL BLVD STE 204
Practice Address - Street 2:
Practice Address - City:DELMAR
Practice Address - State:NY
Practice Address - Zip Code:12054-1331
Practice Address - Country:US
Practice Address - Phone:518-364-5934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-05
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002036171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist