Healthcare Provider Details

I. General information

NPI: 1114833605
Provider Name (Legal Business Name): NATANYA GORDON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 W 252ND ST
BRONX NY
10471-2817
US

IV. Provider business mailing address

615 W 252ND ST
BRONX NY
10471-2817
US

V. Phone/Fax

Practice location:
  • Phone: 516-510-9811
  • Fax:
Mailing address:
  • Phone: 516-510-9811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number027841-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: