Healthcare Provider Details

I. General information

NPI: 1427845205
Provider Name (Legal Business Name): MS. GERALDINE M GORDON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2025
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 MAIN ST STE 212
NYACK NY
10960-3109
US

IV. Provider business mailing address

501 E 165TH ST APT 5A
BRONX NY
10456-6651
US

V. Phone/Fax

Practice location:
  • Phone: 845-540-1002
  • Fax:
Mailing address:
  • Phone: 917-528-2197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP140188
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: