MEDICARE: DR. STELLA GORDIN M.D.

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	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	238862	NY

General Provider Information

NPI Number	:	1235174145
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STELLA GORDIN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 29228
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10087-9228
Country	:	US
Telephone Number	:	800-207-5737
Fax Number	:	610-401-2100

Provider Business Practice Location Address
First Line	:	153 W 11TH ST
Second Line	:	COLEMAN 303
City	:	NEW YORK
State	:	NY
Zip	:	10011-8305
Country	:	US
Telephone Number	:	212-604-8385
Fax Number	:	212-604-8426

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

Provider Enumeration Date	:	06/17/2006
Last Update Date	:	07/08/2007

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