Provider Demographics
NPI:1730468687
Name:SCHMIDT-JORDAN, URSULA (LBMT)
Entity type:Individual
Prefix:
First Name:URSULA
Middle Name:
Last Name:SCHMIDT-JORDAN
Suffix:
Gender:F
Credentials:LBMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 NORTH OLDEN AVENUE, EXT.
Mailing Address - Street 2:SUITE 4
Mailing Address - City:EWING
Mailing Address - State:NJ
Mailing Address - Zip Code:08618-2011
Mailing Address - Country:US
Mailing Address - Phone:609-771-0476
Mailing Address - Fax:
Practice Address - Street 1:1901 NORTH OLDEN AVENUE, EXT.
Practice Address - Street 2:SUITE 4
Practice Address - City:EWING
Practice Address - State:NJ
Practice Address - Zip Code:08618-2011
Practice Address - Country:US
Practice Address - Phone:609-771-0476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-10
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
12360257OtherCAQH