MEDICARE: DR. GREGG 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	207W00000X	Ophthalmology Physician	181037	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083657126
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGG GORDON MD

Provider Business Mailing Address
First Line	:	55 WATER ST
Second Line	:	2ND FLOOR CRED DEPT
City	:	NEW YORK
State	:	NY
Zip	:	10041-0004
Country	:	US
Telephone Number	:	646-680-2888
Fax Number	:	516-542-5556

Provider Business Practice Location Address
First Line	:	20620 LINDEN BLVD
Second Line	:
City	:	CAMBRIA HTS
State	:	NY
Zip	:	11411-1524
Country	:	US
Telephone Number	:	718-479-6600
Fax Number	:	718-264-7080

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

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	03/03/2022

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