Healthcare Provider Details

I. General information

NPI: 1427477041
Provider Name (Legal Business Name): STEVEN GORDON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2014
Last Update Date: 10/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 10TH ST
NIAGARA FALLS NY
14301-1813
US

IV. Provider business mailing address

621 10TH ST
NIAGARA FALLS NY
14301-1813
US

V. Phone/Fax

Practice location:
  • Phone: 716-278-4000
  • Fax:
Mailing address:
  • Phone: 716-278-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number293763
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: