Provider Demographics
NPI:1093866386
Name:GORDIN, INNA (MD)
Entity Type:Individual
Prefix:DR
First Name:INNA
Middle Name:
Last Name:GORDIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1664 E 14TH ST STE 302
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-1167
Mailing Address - Country:US
Mailing Address - Phone:718-382-0500
Mailing Address - Fax:718-382-7025
Practice Address - Street 1:1664 E 14TH ST STE 302
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1167
Practice Address - Country:US
Practice Address - Phone:718-382-0500
Practice Address - Fax:718-382-7025
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY113620583207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01737246Medicaid
NY01737246Medicaid
NY20N411Medicare ID - Type Unspecified