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General NPI Number Information
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NPI Number | 1285287961
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Entity Type | Individual
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Provider Name | JAZMIN RAYLENE GEM GORDON-ROSE
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Gender | Female
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Dates
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Enumeration Date | 07/22/2019
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Last Update Date | 07/22/2019
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Provider Practice Location Address
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Address Line | 1310 ROCKAWAY PKWY
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City | BROOKLYN
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State | NY
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Zip | 11236-2339
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Country | US
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Telephone | 718-272-3300
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Fax | 718-927-1801
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Provider Business Mailing Address
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Address Line | 125 BROAD ST FL 3
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City | NEW YORK
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State | NY
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Zip | 10004-2768
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Country | US
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Telephone | 212-385-3030
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 103191-1
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License Number State | NY
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