MEDICARE: ERROL GORDON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2100X	Acute Care Nurse Practitioner	431431	NY

General Provider Information

NPI Number	:	1104210012
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERROL GORDON

Provider Business Mailing Address
First Line	:	2032 BAY RIDGE AVE
Second Line	:	APT 4
City	:	BROOKLYN
State	:	NY
Zip	:	11204-4643
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2032 BAY RIDGE AVE
Second Line	:	APT 4
City	:	BROOKLYN
State	:	NY
Zip	:	11204-4643
Country	:	US
Telephone Number	:	917-648-7303
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2015
Last Update Date	:	07/13/2021

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