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General NPI Number Information
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NPI Number | 1457192189
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Entity Type | Individual
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Provider Name | EMILY GORDON
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Gender | Female
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Dates
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Enumeration Date | 06/05/2024
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Last Update Date | 06/05/2024
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Provider Practice Location Address
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Address Line | 156 W 56TH ST STE 1804
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City | NEW YORK
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State | NY
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Zip | 10019-3878
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Country | US
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Telephone | 212-851-8100
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Fax | 212-537-0102
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Provider Business Mailing Address
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Address Line | 333 HART AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10310-3046
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Country | US
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Telephone | 718-873-3818
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | R041533
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License Number State | NY
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