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General NPI Number Information
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NPI Number | 1174541106
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Entity Type | Organization
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Legal Business Name | STEPHEN J. GORDON, M.D.,P.A.
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 317 CLEVELAND AVE., 2ND FLOOR
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City | HIGHLAND PARK
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State | NJ
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Zip | 08904
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Country | US
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Telephone | 732-545-0362
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Fax |
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Provider Business Mailing Address
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Address Line | 317 CLEVELAND AVE., 2ND FLOOR
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City | HIGHLAND PARK
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State | NJ
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Zip | 08904
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | STEPHEN J. GORDON J GORDON
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Credential | M.D.
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Telephone | 732-545-0362
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 25MA04275700
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License Number State | NJ
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