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General NPI Number Information
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NPI Number | 1811970692
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Entity Type | Individual
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Provider Name | LAWRENCE JAY GORDON MD
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Gender | Male
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Dates
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Enumeration Date | 11/25/2005
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Last Update Date | 10/09/2025
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Provider Practice Location Address
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Address Line | 2004 ROUTE 17M
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City | GOSHEN
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State | NY
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Zip | 10924-5210
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Country | US
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Telephone | 845-294-0661
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Fax | 845-818-9646
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Provider Business Mailing Address
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Address Line | 2004 ROUTE 17M
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City | GOSHEN
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State | NY
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Zip | 10924-5210
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Country | US
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Telephone | 845-294-0661
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Fax | 845-818-9646
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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 | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 183723
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207YX0007X
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Taxonomy Name | Plastic Surgery within the Head & Neck (Otolaryngology) Physician
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License Number | 183723
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 207YX0602X
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Taxonomy Name | Otolaryngic Allergy Physician
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License Number | 183723
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License Number State | NY
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