MEDICARE: DR. STANLEY L GORDON MD

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	207X00000X	Orthopaedic Surgery Physician	146180-1	NY

General Provider Information

NPI Number	:	1467427799
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STANLEY L GORDON MD

Provider Business Mailing Address
First Line	:	44 ROCKLEDGE DR
Second Line	:
City	:	PELHAM MANOR
State	:	NY
Zip	:	10803-3311
Country	:	US
Telephone Number	:	914-738-3854
Fax Number	:	914-738-0133

Provider Business Practice Location Address
First Line	:	450 CLARKSON AVENUE
Second Line	:	BOX 30
City	:	BROOKLYN
State	:	NY
Zip	:	11203-2098
Country	:	US
Telephone Number	:	718-270-6317
Fax Number	:	718-270-3983

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

Provider Enumeration Date	:	02/21/2006
Last Update Date	:	07/08/2007

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