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NPI Code Detail

MEDICARE: DR. MARK GORDIN MD

MEDICARE:  DR. MARK  GORDIN  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
12084P0800XPsychiatry Physician25MA05501000NJ

General Provider Information

NPI Number : 1588693642
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARK GORDIN MD
Provider Business Mailing Address
First Line : 206 SAYRE DR
Second Line :
City : PRINCETON
State : NJ
Zip : 08540-5844
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 108 ALDEN ST
Second Line :
City : CRANFORD
State : NJ
Zip : 07016-2131
Country : US
Telephone Number : 908-497-3968
Fax Number : 908-497-3989
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/01/2006
Last Update Date : 10/13/2011

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