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General NPI Number Information
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NPI Number | 1396036372
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Entity Type | Organization
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Legal Business Name | MARK GORDON, MD, PC
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Dates
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Enumeration Date | 04/26/2011
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Last Update Date | 04/26/2011
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Provider Practice Location Address
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Address Line | 2 LONGVIEW AVE STE 302
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City | WHITE PLAINS
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State | NY
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Zip | 10601-5000
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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 STE 302
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City | WHITE PLAINS
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State | NY
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Zip | 10601-5000
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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 | PRESIDENT
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Name | DR. MARK S GORDON
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Credential | M.D.
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Telephone | 914-684-5884
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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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