Healthcare Provider Details

I. General information

NPI: 1295334076
Provider Name (Legal Business Name): PAIGE GORDON PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2020
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date: 10/22/2020
Reactivation Date: 01/27/2022

III. Provider practice location address

1000 E GENESEE ST STE 500
SYRACUSE NY
13210-1885
US

IV. Provider business mailing address

1000 E GENESEE ST STE 500
SYRACUSE NY
13210-1885
US

V. Phone/Fax

Practice location:
  • Phone: 315-471-8388
  • Fax:
Mailing address:
  • Phone: 315-471-8388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number027143
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: