Healthcare Provider Details

I. General information

NPI: 1962586719
Provider Name (Legal Business Name): PHILIPPA RUTH GORDON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 06/25/2020
Certification Date: 06/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 COURT ST
BROOKLYN NY
11231-4405
US

IV. Provider business mailing address

300 COURT ST
BROOKLYN NY
11231-4405
US

V. Phone/Fax

Practice location:
  • Phone: 347-763-0084
  • Fax: 347-763-0073
Mailing address:
  • Phone: 347-763-0084
  • Fax: 347-763-0073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number176609
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: