Provider Demographics
NPI:1164598256
Name:GORDON, TONI G (PHD)
Entity Type:Individual
Prefix:DR
First Name:TONI
Middle Name:G
Last Name:GORDON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 JERICHO TURNPIKE SUITE 103
Mailing Address - Street 2:SYOSSET SPEECH & HEARING CENTER
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791
Mailing Address - Country:US
Mailing Address - Phone:516-364-1234
Mailing Address - Fax:576-364-3132
Practice Address - Street 1:175 JERICHO TURNPIKE SUITE 103
Practice Address - Street 2:SYOSSET SPEECH & HEARING CENTER
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791
Practice Address - Country:US
Practice Address - Phone:516-364-1234
Practice Address - Fax:576-364-3132
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000230231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1911Medicare ID - Type Unspecified