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General NPI Number Information
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NPI Number | 1447804380
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Entity Type | Individual
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Provider Name | STEFANIE ERIN GORDON OTD, OTR/L
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Gender | Female
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Dates
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Enumeration Date | 07/29/2019
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Last Update Date | 07/29/2019
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Provider Practice Location Address
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Address Line | 101 W 116TH ST
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City | NEW YORK
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State | NY
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Zip | 10026-2521
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Country | US
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Telephone | 212-787-8315
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Fax |
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Provider Business Mailing Address
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Address Line | 298 PENNS WAY
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City | BASKING RIDGE
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State | NJ
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Zip | 07920-3038
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Country | US
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Telephone | 908-256-1682
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Fax |
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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 | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 023732
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License Number State | NY
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