MEDICARE: REBECCA A 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	363LF0000X	Family Nurse Practitioner	F356193-01	NY

General Provider Information

NPI Number	:	1568259018
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA A GORDON

Provider Business Mailing Address
First Line	:	210 SHORE RD APT 3A
Second Line	:
City	:	LONG BEACH
State	:	NY
Zip	:	11561-4271
Country	:	US
Telephone Number	:	631-487-5301
Fax Number	:

Provider Business Practice Location Address
First Line	:	210 SHORE RD APT 3A
Second Line	:
City	:	LONG BEACH
State	:	NY
Zip	:	11561-4271
Country	:	US
Telephone Number	:	631-487-5301
Fax Number	:

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

Provider Enumeration Date	:	04/21/2025
Last Update Date	:	04/21/2025

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Directions to “ REBECCA A GORDON ” Practice Location

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