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NPI Code Detail

MEDICARE: CHAYA GORDON R.N.

MEDICARE: CHAYA GORDON R.N.
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
1163W00000XRegistered Nurse3515221-1NY

General Provider Information

NPI Number : 1154565059
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHAYA GORDON R.N.
Provider Business Mailing Address
First Line : 1106 BEACH 12TH ST
Second Line :
City : FAR ROCKAWAY
State : NY
Zip : 11691-4708
Country : US
Telephone Number : 718-471-0291
Fax Number :
Provider Business Practice Location Address
First Line : 264 BEACH 19TH ST
Second Line :
City : FAR ROCKAWAY
State : NY
Zip : 11691-4431
Country : US
Telephone Number : 718-868-2961
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/23/2009
Last Update Date : 04/23/2009

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