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General NPI Number Information
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NPI Number | 1003188020
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Entity Type | Organization
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Legal Business Name | EMPIRE GATE MEDICAL P.C.
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Dates
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Enumeration Date | 02/07/2012
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Last Update Date | 05/22/2014
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Provider Practice Location Address
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Address Line | 8810 PARSONS BLVD
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City | JAMAICA
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State | NY
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Zip | 11432-3842
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Country | US
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Telephone | 718-291-8111
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Fax | 718-487-9343
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Provider Business Mailing Address
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Address Line | 111 BROADWAY #1005
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City | NEW YORK
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State | NY
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Zip | 10006-1951
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Country | US
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Telephone | 646-217-4610
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Fax | 917-591-8596
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Authorized Official
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Title or Position | COO
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Name | MR. ROBERT GORDON
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Credential |
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Telephone | 646-217-4610
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 163293
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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