Provider Demographics
NPI:1104210012
Name:GORDON, ERROL
Entity Type:Individual
Prefix:
First Name:ERROL
Middle Name:
Last Name:GORDON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2032 BAY RIDGE AVE
Mailing Address - Street 2:APT 4
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-4643
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2032 BAY RIDGE AVE
Practice Address - Street 2:APT 4
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-4643
Practice Address - Country:US
Practice Address - Phone:917-648-7303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-28
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY431431363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care