Provider Demographics
NPI:1164477238
Name:GORDON, EMILY LINZER (MD)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:LINZER
Last Name:GORDON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:SHEVA
Other - Last Name:LINZER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:20 GRAND STREET, 3RD FL
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:NY
Mailing Address - Zip Code:10990-1035
Mailing Address - Country:US
Mailing Address - Phone:845-987-3906
Mailing Address - Fax:845-987-5979
Practice Address - Street 1:70 HATFIELD LN STE 101
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:NY
Practice Address - Zip Code:10924-6735
Practice Address - Country:US
Practice Address - Phone:845-294-8888
Practice Address - Fax:845-294-1699
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY192255 1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP00302564OtherRAILROAD MEDICARE
NY01534385Medicaid
NY01534385Medicaid
NYG13214Medicare UPIN