Provider Demographics
NPI:1023195484
Name:GORDON, JILL S (AUD)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:S
Last Name:GORDON
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4257 US HIGHWAY 9 BLDG 6
Mailing Address - Street 2:FREEHOLD OFFICE PLAZA
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-8310
Mailing Address - Country:US
Mailing Address - Phone:732-303-9660
Mailing Address - Fax:732-303-1810
Practice Address - Street 1:4257 US HIGHWAY 9 BLDG 6
Practice Address - Street 2:FREEHOLD OFFICE PLAZA
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-8310
Practice Address - Country:US
Practice Address - Phone:732-303-9660
Practice Address - Fax:732-303-1810
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJYA00174231H00000X
NJMG00564237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Not Answered237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7939809Medicaid
NJR62463Medicare UPIN
NJ7939809Medicaid