Basic Information
| Provider Information | |||||||||
| NPI: | 1134708126 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FINCK | ||||||||
| FirstName: | JORDAN | ||||||||
| MiddleName: | RAY | ||||||||
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| Credential: | DPM | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | FINCK | ||||||||
| OtherFirstName: | JORDAN | ||||||||
| OtherMiddleName: | RAY | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | DPM | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1434 CAMBRIDGE CT | ||||||||
| Address2: | |||||||||
| City: | MADISON | ||||||||
| State: | SD | ||||||||
| PostalCode: | 570421220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6054803390 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 150 BERGEN ST | ||||||||
| Address2: | |||||||||
| City: | NEWARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 071032496 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9739724300 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2021 | ||||||||
| LastUpdateDate: | 04/06/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.