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General NPI Number Information
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NPI Number | 1558295873
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Entity Type | Organization
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Legal Business Name | RODRICO GORDON ADULT - GERONTOLOGY NP P.C.
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Dates
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Enumeration Date | 06/11/2026
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Last Update Date | 06/11/2026
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Provider Practice Location Address
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Address Line | 44 RIFLE CAMP RD
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City | WOODLAND PARK
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State | NJ
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Zip | 07424-3353
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Country | US
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Telephone | 929-329-7900
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Fax | 929-419-0351
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Provider Business Mailing Address
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Address Line | 511 S ORANGE AVE
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City | NEWARK
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State | NJ
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Zip | 07103-1342
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Country | US
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Telephone | 929-329-7900
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Fax | 929-419-0351
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Authorized Official
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Title or Position | OWNER
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Name | RODRICO GORDON
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Credential |
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Telephone | 929-329-7900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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