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NPI Code Detail

MEDICARE: DIANA GORDON

MEDICARE: DIANA GORDON
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
1225700000XMassage Therapist015809NY

General Provider Information

NPI Number : 1881329431
Entity Type Code : Individual
Provider Name (Legal Business Name) : DIANA GORDON
Provider Business Mailing Address
First Line : 150 W 28TH ST STE 1901
Second Line :
City : NEW YORK
State : NY
Zip : 10001-6179
Country : US
Telephone Number : 516-670-5496
Fax Number :
Provider Business Practice Location Address
First Line : 150 W 28TH ST STE 1901
Second Line :
City : NEW YORK
State : NY
Zip : 10001-6179
Country : US
Telephone Number : 516-670-5496
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/18/2022
Last Update Date : 01/19/2023

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Directions to “ DIANA GORDON ” Practice Location

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