Provider Demographics
NPI:1053577312
Name:SUDBERG, JORDAN (MD)
Entity type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:
Last Name:SUDBERG
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 1:50 E 28TH ST APT 21D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-7980
Mailing Address - Country:US
Mailing Address - Phone:646-239-8418
Mailing Address - Fax:
Practice Address - Street 1:1717 VETERANS MEMORIAL HWY STE 1
Practice Address - Street 2:
Practice Address - City:ISLANDIA
Practice Address - State:NY
Practice Address - Zip Code:11749-1532
Practice Address - Country:US
Practice Address - Phone:631-203-4300
Practice Address - Fax:631-203-4305
Is Sole Proprietor?:No
Enumeration Date:2008-08-05
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2727742081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine