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1013904333

NPI Code Detail

MEDICARE: MR. MICHAEL S GORDON MD

MEDICARE: MR. MICHAEL S GORDON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	25MA05912000	NJ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	050071446	OTHER	NJ	RAIL ROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	0658805000	OTHER	NJ	AMERIHEALTH PRODUCTS
4	1097352	OTHER	NJ	HORIZON MERCY

General Provider Information

NPI Number	:	1013904333
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL S GORDON MD

Provider Business Mailing Address
First Line	:	PO BOX 10439
Second Line	:
City	:	TRENTON
State	:	NJ
Zip	:	08650-4039
Country	:	US
Telephone Number	:	609-581-5303
Fax Number	:	609-631-6839

Provider Business Practice Location Address
First Line	:	2119 HIGHWAY 33
Second Line	:	SUITE B
City	:	HAMILTON SQUARE
State	:	NJ
Zip	:	08690-1740
Country	:	US
Telephone Number	:	609-581-5303
Fax Number	:	609-631-6839

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2005
Last Update Date	:	11/16/2011

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Directions to “ MR. MICHAEL S GORDON MD” Practice Location

Language	Start Address	Practice Location

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