Healthcare Provider Details

I. General information

NPI: 1952625022
Provider Name (Legal Business Name): DANIELLE NICOLE GORDON PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2010
Last Update Date: 03/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 YORK AVE
NEW YORK NY
10065-6007
US

IV. Provider business mailing address

1275 YORK AVE
NEW YORK NY
10065-6007
US

V. Phone/Fax

Practice location:
  • Phone: 212-639-8464
  • Fax:
Mailing address:
  • Phone: 212-639-8464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number28RI03084000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: