MEDICARE: DR. ALAN STUART GORDON ED.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	103TC0700X	Clinical Psychologist	SI01000	NJ

General Provider Information

NPI Number	:	1538273065
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALAN STUART GORDON ED.D.

Provider Business Mailing Address
First Line	:	196 PRINCETON HIGHTSTOWN RD
Second Line	:	BUILDING 1 SECOND FLOOR
City	:	PRINCETON JUNCTION
State	:	NJ
Zip	:	08550-1672
Country	:	US
Telephone Number	:	609-799-3866
Fax Number	:	609-799-7930

Provider Business Practice Location Address
First Line	:	196 PRINCETON HIGHTSTOWN RD
Second Line	:	BUILDING 1 SECOND FLOOR
City	:	PRINCETON JUNCTION
State	:	NJ
Zip	:	08550-1672
Country	:	US
Telephone Number	:	609-799-3866
Fax Number	:	609-799-7930

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

Provider Enumeration Date	:	08/19/2006
Last Update Date	:	07/08/2007

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