MEDICARE: DR. MICHAEL A. 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	207Y00000X	Otolaryngology Physician	171522	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	:	1356306807
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL A. GORDON MD

Provider Business Mailing Address
First Line	:	660 WHITE PLAINS RD FL 4
Second Line	:
City	:	TARRYTOWN
State	:	NY
Zip	:	10591-5139
Country	:	US
Telephone Number	:	914-984-2546
Fax Number	:

Provider Business Practice Location Address
First Line	:	990 STEWART AVE
Second Line	:	SUITE 610
City	:	GARDEN CITY
State	:	NY
Zip	:	11530-4838
Country	:	US
Telephone Number	:	516-222-1881
Fax Number	:	516-222-1885

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

Provider Enumeration Date	:	04/19/2006
Last Update Date	:	04/02/2019

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