Healthcare Provider Details

I. General information

NPI: 1053325639
Provider Name (Legal Business Name): ALAN L GORDON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 12/12/2023
Certification Date: 12/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 COLUMBIA TPKE
FLORHAM PARK NJ
07932-1299
US

IV. Provider business mailing address

222 COLUMBIA TPKE
FLORHAM PARK NJ
07932-1299
US

V. Phone/Fax

Practice location:
  • Phone: 973-261-9075
  • Fax:
Mailing address:
  • Phone: 973-261-9075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number25MA10442200
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number25MA10442200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: