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General NPI Number Information
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NPI Number | 1386968220
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Entity Type | Organization
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Legal Business Name | LAWRENCE GORDON MD PLLC
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Dates
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Enumeration Date | 03/22/2010
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Last Update Date | 03/22/2010
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Provider Practice Location Address
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Address Line | 521 ROUTE 515
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City | VERNON
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State | NJ
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Zip | 07462-3033
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Country | US
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Telephone | 845-294-0661
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Fax |
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Provider Business Mailing Address
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Address Line | 1 HARRIMAN DR
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City | GOSHEN
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State | NY
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Zip | 10924-2406
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Country | US
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Telephone | 845-294-0661
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Fax | 845-818-9646
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Authorized Official
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Title or Position | CEO
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Name | DR. LAWRENCE J GORDON
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Credential | MD
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Telephone | 845-294-0661
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207YX0905X
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Taxonomy Name | Otolaryngology/Facial Plastic Surgery Physician
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License Number | 25MA08712000
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License Number State | NJ
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