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General NPI Number Information
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NPI Number | 1407825516
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Entity Type | Individual
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Provider Name | WAYNE GORDON M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/14/2006
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Last Update Date | 04/11/2011
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Provider Practice Location Address
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Address Line | 5 E. 98TH STREET 6TH FLOOR BOX 1240 B
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City | NEW YORK
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State | NY
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Zip | 10029
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Country | US
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Telephone | 212-659-9363
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Fax | 212-348-5901
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Provider Business Mailing Address
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Address Line | 5 E. 98TH STREET 6TH FLOOR BOX 1240 B
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City | NEW YORK
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State | NY
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Zip | 10029
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Country | US
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Telephone | 212-659-8353
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Fax | 212-348-5901
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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 | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number | 004201-1
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License Number State | NY
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