NPIMap

Organization Active NPI

Jordan Lissauer Orthodontics PC

Doing business as 103 Orthodontics

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Staten Island, NY
National Provider Identifier
1851945794
Registry record updated Aug 3, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X
Legal business name
JORDAN LISSAUER ORTHODONTICS PC
Doing business as
103 Orthodontics
Practice address
3767 Hylan Blvd
Staten Island, NY 10308-3505
Phone
(718) 966-2720
NPI assigned
Jul 29, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 3, 2026

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

Authorized official

Name
Jordan Lissauer, DMDNPI 1730467564
Title
President
Phone
(718) 966-2720

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthodontics and Dentofacial Orthopedics DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223X0400X Primary

Addresses

Primary practice location

3767 Hylan Blvd
Staten Island, NY 10308-3505

Mailing address

3767 Hylan Blvd
Staten Island, NY 10308-3518
Phone (718) 966-2720

Other practice location 1

129 Slosson Ave
Staten Island, NY 10314-2522
Phone (718) 966-2720

Other names 1

  • 103 Orthodontics Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1564358400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1785715200000",
    "number": "1851945794",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3767 HYLAN BLVD",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103083518",
            "telephone_number": "718-966-2720"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3767 HYLAN BLVD",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103083505",
            "telephone_number": "718-966-2720"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "129 Slosson Ave",
            "address_purpose": "LOCATION",
            "city": "Staten Island",
            "state": "NY",
            "postal_code": "103142522",
            "country_code": "US",
            "telephone_number": "718-966-2720",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "JORDAN LISSAUER ORTHODONTICS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-29",
        "last_updated": "2026-08-03",
        "certification_date": "2026-08-03",
        "status": "A",
        "authorized_official_last_name": "LISSAUER",
        "authorized_official_first_name": "JORDAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "718-966-2720",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "103 Orthodontics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Staten Island, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2026; 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.