Provider Demographics
NPI:1154316230
Name:GORDON, PETER ELIOT (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:ELIOT
Last Name:GORDON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 BALTIC ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-6620
Mailing Address - Country:US
Mailing Address - Phone:718-866-6521
Mailing Address - Fax:718-666-5212
Practice Address - Street 1:218 BALTIC ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-6620
Practice Address - Country:US
Practice Address - Phone:718-866-6521
Practice Address - Fax:718-666-5212
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY203705207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG31739Medicare UPIN
NYG31739Medicare UPIN