Healthcare Provider Details

I. General information

NPI: 1023195484
Provider Name (Legal Business Name): JILL S GORDON AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4257 US HIGHWAY 9 BLDG 6 FREEHOLD OFFICE PLAZA
FREEHOLD NJ
07728-8310
US

IV. Provider business mailing address

4257 US HIGHWAY 9 BLDG 6 FREEHOLD OFFICE PLAZA
FREEHOLD NJ
07728-8310
US

V. Phone/Fax

Practice location:
  • Phone: 732-303-9660
  • Fax: 732-303-1810
Mailing address:
  • Phone: 732-303-9660
  • Fax: 732-303-1810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberYA00174
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberMG00564
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: