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General NPI Number Information
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NPI Number | 1184186066
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Entity Type | Individual
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Provider Name | MAX J GORDON DMD
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Gender | Male
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Dates
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Enumeration Date | 04/01/2019
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Last Update Date | 08/28/2025
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Provider Practice Location Address
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Address Line | 1175 PARK AVE
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City | NEW YORK
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State | NY
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Zip | 10128-1211
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Country | US
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Telephone | 929-209-3936
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Fax |
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Provider Business Mailing Address
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Address Line | 302 LUHMANN DR
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City | NEW MILFORD
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State | NJ
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Zip | 07646-2327
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Country | US
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Telephone | 516-587-0663
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 22DI02795400
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 061250
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 07549
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License Number State | NJ
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