Provider Demographics
NPI:1144066994
Name:INDYK, JORDAN LYNN
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:LYNN
Last Name:INDYK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 SEYMOUR AVE
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07095-2407
Mailing Address - Country:US
Mailing Address - Phone:908-698-3574
Mailing Address - Fax:
Practice Address - Street 1:48 SEYMOUR AVE
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07095-2407
Practice Address - Country:US
Practice Address - Phone:908-698-3574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06745100104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker