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General NPI Number Information
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NPI Number | 1346232899
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Entity Type | Individual
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Provider Name | MARK STEPHEN GORDON MD
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Gender | Male
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Dates
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Enumeration Date | 08/19/2005
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Last Update Date | 06/29/2011
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Provider Practice Location Address
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Address Line | 2 LONGVIEW AVE SUITE 302
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City | WHITE PLAINS
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State | NY
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Zip | 10601-5002
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Country | US
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Telephone | 914-684-5884
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Fax | 914-684-6178
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Provider Business Mailing Address
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Address Line | 2 LONGVIEW AVE SUITE 302
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City | WHITE PLAINS
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State | NY
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Zip | 10601-5002
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Country | US
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Telephone | 914-684-5884
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Fax | 914-684-6178
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 155799
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License Number State | NY
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