Jordan Sudberg, M.D

Primary specialty

Sports Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081S0010X

License

272774 Issued in NY

Practice address

1717 Veterans Memorial Hwy Ste 1
Islandia, NY 11749-1532

Phone

(631) 203-4300

Fax

(631) 203-4305

NPI assigned

Aug 5, 2008

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Handworks OT PC

  • Specialist
  • Flushing, NY
  • NPI 1639441652
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1217894400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730332800000",
    "number": "1053577312",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "50 E 28TH ST APT 21D",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100167980",
            "telephone_number": "646-239-8418"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1717 VETERANS MEMORIAL HWY STE 1",
            "city": "ISLANDIA",
            "state": "NY",
            "postal_code": "117491532",
            "telephone_number": "631-203-4300",
            "fax_number": "631-203-4305"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUDBERG",
        "first_name": "JORDAN",
        "name_prefix": "Dr.",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-08-05",
        "last_updated": "2024-10-31",
        "certification_date": "2024-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2081S0010X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Sports Medicine",
            "state": "NY",
            "license": "272774",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Speech Language Pathology in Motion, PLLC
• St James Taxi Service Inc
• Lauren Staudt
• Kathleen Stergiopoulos, M.D.
• Anna Stern, MD
• Suffolk Medical Services PLLC
• Lorraine Sullivan, NP
• Tracy Sullivan, N.P.
• Donna Swan, LPN
• Ruth Tapia

• Sports Medicine (Physical Medicine & Rehabilitation) Physician in Islandia, NY
• Providers in Islandia, NY by specialty
• Sports Medicine (Physical Medicine & Rehabilitation) Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.