Healthcare Provider Details

I. General information

NPI: 1780734608
Provider Name (Legal Business Name): NEIL ALAN GORDON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

539 DANBURY RD
WILTON CT
06897-2216
US

IV. Provider business mailing address

539 DANBURY RD
WILTON CT
06897-2216
US

V. Phone/Fax

Practice location:
  • Phone: 203-834-7700
  • Fax: 203-834-8877
Mailing address:
  • Phone: 203-834-7700
  • Fax: 203-834-8877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number035181
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: