Healthcare Provider Details

I. General information

NPI: 1184250896
Provider Name (Legal Business Name): DANIELLE JOY GORDON MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2020
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51-53 KENOSIA AVE
DANBURY CT
06810-2304
US

IV. Provider business mailing address

51-53 KENOSIA AVE
DANBURY CT
06810-2304
US

V. Phone/Fax

Practice location:
  • Phone: 203-748-0330
  • Fax:
Mailing address:
  • Phone: 203-748-0330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number80570
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: