Provider Demographics
NPI:1215389739
Name:GOURDINE, DON (MS, PA-C)
Entity Type:Individual
Prefix:
First Name:DON
Middle Name:
Last Name:GOURDINE
Suffix:
Gender:M
Credentials:MS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 CUMBERLAND CT
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-1456
Mailing Address - Country:US
Mailing Address - Phone:201-232-4458
Mailing Address - Fax:
Practice Address - Street 1:3 CUMBERLAND CT
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-1456
Practice Address - Country:US
Practice Address - Phone:201-232-4458
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-08
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00397900363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical