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General NPI Number Information
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NPI Number | 1285740787
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Entity Type | Individual
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Provider Name | BARRY MARK GORDON M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/21/2006
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Last Update Date | 07/18/2019
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Provider Practice Location Address
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Address Line | 809 RIVER AVE
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City | LAKEWOOD
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State | NJ
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Zip | 08701-5286
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Country | US
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Telephone | 732-905-9944
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Fax | 732-444-3118
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Provider Business Mailing Address
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Address Line | 212 VAN HOUTEN AVE APARTMENT 2
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City | PASSAIC
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State | NJ
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Zip | 07055-4607
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Country | US
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Telephone | 848-299-3418
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 273313
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 25MA07707800
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License Number State | NJ
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