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General NPI Number Information
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NPI Number | 1659455756
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Entity Type | Organization
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Legal Business Name | GARY M GORDON DPM PC
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 03/18/2008
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Provider Practice Location Address
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Address Line | 2285 CROSS RD
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City | GLENSIDE
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State | PA
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Zip | 19038
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Country | US
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Telephone | 215-887-5910
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Fax | 215-887-0387
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Provider Business Mailing Address
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Address Line | 2285 CROSS RD
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City | GLENSIDE
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State | PA
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Zip | 19038
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Country | US
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Telephone | 215-887-5910
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Fax | 215-887-0387
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Authorized Official
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Title or Position | PRESIDENT
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Name | GARY M GORDON
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Credential | DPM
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Telephone | 215-887-5910
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | SC001507L
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | SC00L57L
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License Number State | PA
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