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General NPI Number Information
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NPI Number | 1861822140
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Entity Type | Individual
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Provider Name | CLAIRE LOUISE GORDON MD
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Gender | Female
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Dates
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Enumeration Date | 11/22/2013
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Last Update Date | 11/22/2013
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Provider Practice Location Address
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Address Line | 622 W 168TH ST
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City | NEW YORK
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State | NY
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Zip | 10032-3720
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Country | US
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Telephone | 212-342-5155
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Fax | 232-305-4885
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Provider Business Mailing Address
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Address Line | 630 WEST 168TH STREET, BOX 4
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City | NEW YORK
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State | NY
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Zip | 10032-3725
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Country | US
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Telephone | 212-342-5155
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Fax | 212-305-4885
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 268502
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License Number State | NY
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