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NPI Code Detail

MEDICARE: RODRICO GORDON ANP

MEDICARE: RODRICO GORDON ANP
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
1363LA2200XAdult Health Nurse PractitionerF310858NY
2363LA2200XAdult Health Nurse Practitioner26NJ15124300NJ

General Provider Information

NPI Number : 1063783926
Entity Type Code : Individual
Provider Name (Legal Business Name) : RODRICO GORDON ANP
Provider Business Mailing Address
First Line : 281 EDGECOMBE AVE
Second Line : APT 7F
City : NEW YORK
State : NY
Zip : 10031-3014
Country : US
Telephone Number : 718-600-0075
Fax Number :
Provider Business Practice Location Address
First Line : 2015 GRAND CONCOURSE
Second Line :
City : BRONX
State : NY
Zip : 10453-4303
Country : US
Telephone Number : 718-583-7736
Fax Number : 718-537-6180
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/24/2012
Last Update Date : 06/11/2026

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Directions to “ RODRICO GORDON ANP” Practice Location

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