Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | MD068768L | PA |
Y | 2080P0201X | Pediatric Allergist | MD068768L | PA |
NPI | 1033123591 |
---|---|
Provider Name | Jordan S Orange |
First Address | New York, NY 10032-3725 |
Second Address | New York, NY 10032-3725 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2006 |
Last Update Date | 12/05/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0015806 | (05) | NJ |
100820449 | (05) | PA |
H61666 | (02) |