Healthcare Provider Details

I. General information

NPI: 1649328832
Provider Name (Legal Business Name): NORTH SALEM PSYCHIATRIC SERVICES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

388 HARDSCRABBLE RD
NORTH SALEM NY
10560-1020
US

IV. Provider business mailing address

388 HARDSCRABBLE RD
NORTH SALEM NY
10560-1020
US

V. Phone/Fax

Practice location:
  • Phone: 914-669-5526
  • Fax: 914-669-6051
Mailing address:
  • Phone: 914-669-5526
  • Fax: 914-669-6051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number086183
License Number StateNY

VIII. Authorized Official

Name: DR. EDWARD GORDON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 914-669-5526