Individual provider · NPI-1
Dr. Jordan Sudberg, M.D
Physical Medicine & Rehabilitation, Sports Medicine · Islandia, NY
NPI number1053577312
StatusActive
Last updated in NPPESOct 31, 2024
Details
- NPI
- 1053577312
- Entity type
- Individual (NPI-1)
- Name
- Dr. Jordan Sudberg
- Credential
- M.D
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Aug 5, 2008
- Certification date
- Oct 31, 2024
- Last updated
- Oct 31, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 2081S0010X | Physical Medicine & Rehabilitation, Sports Medicine | 272774 | NY | Yes |
Practice location
1717 Veterans Memorial Hwy Ste 1Islandia, NY 11749-1532
Phone 631-203-4300 · Fax 631-203-4305
Mailing address
50 E 28th St Apt 21dNew York, NY 10016-7980
Phone 646-239-8418
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