MEDICARE: DR. YANA 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	075537	NJ

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	:	1114910007
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. YANA GORDON MD

Provider Business Mailing Address
First Line	:	118 NORTH BEDFORD ROAD
Second Line	:	2ND FLOOR
City	:	MOUNT KISCO
State	:	NY
Zip	:	10549-1009
Country	:	US
Telephone Number	:	914-666-8866
Fax Number	:	914-666-6777

Provider Business Practice Location Address
First Line	:	7600 RIVER RD
Second Line	:	PALISADES MEDICAL CENTER
City	:	NORTH BERGEN
State	:	NJ
Zip	:	07047-6217
Country	:	US
Telephone Number	:	201-854-5172
Fax Number	:

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

Provider Enumeration Date	:	08/25/2005
Last Update Date	:	07/06/2017

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