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General NPI Number Information
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NPI Number | 1326924317
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Entity Type | Organization
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Legal Business Name | RODRICO GORDON NP IN ADULT HEALTH PLLC
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Dates
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Enumeration Date | 08/14/2025
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Last Update Date | 08/20/2025
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Provider Practice Location Address
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Address Line | 19019 LINDEN BLVD # 18
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City | JAMAICA
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State | NY
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Zip | 11412-3361
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Country | US
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Telephone | 929-329-7900
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Fax |
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Provider Business Mailing Address
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Address Line | 13517 217TH ST
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City | LAURELTON
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State | NY
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Zip | 11413-1929
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Country | US
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Telephone | 929-329-7900
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | RODRICO GORDON
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Credential |
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Telephone | 929-329-7900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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