Healthcare Provider Details

I. General information

NPI: 1467427799
Provider Name (Legal Business Name): STANLEY L GORDON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 CLARKSON AVENUE BOX 30
BROOKLYN NY
11203-2098
US

IV. Provider business mailing address

44 ROCKLEDGE DR
PELHAM MANOR NY
10803-3311
US

V. Phone/Fax

Practice location:
  • Phone: 718-270-6317
  • Fax: 718-270-3983
Mailing address:
  • Phone: 914-738-3854
  • Fax: 914-738-0133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number146180-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: