Healthcare Provider Details

I. General information

NPI: 1497797641
Provider Name (Legal Business Name): JAMES RUSSELL GORDON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BYRAM BROOK PL STE 200
ARMONK NY
10504-2323
US

IV. Provider business mailing address

1 BYRAM BROOK PL
ARMONK NY
10504-2316
US

V. Phone/Fax

Practice location:
  • Phone: 914-820-0000
  • Fax: 914-219-5824
Mailing address:
  • Phone: 914-820-0000
  • Fax: 914-219-5824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number208880
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License Number208880-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: