Healthcare Provider Details

I. General information

NPI: 1427097500
Provider Name (Legal Business Name): LEONARD F GORDON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 SALEM WOODSTOWN RD
SALEM NJ
08079-2064
US

IV. Provider business mailing address

134 BRIDGETON PIKE STE D
MULLICA HILL NJ
08062-2616
US

V. Phone/Fax

Practice location:
  • Phone: 856-339-6054
  • Fax: 856-935-6714
Mailing address:
  • Phone: 856-339-6054
  • Fax: 856-935-6714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License NumberMD021520E
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number25MA05000400
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD021520E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: