Provider Demographics
NPI:1275502460
Name:GORDON, FREDERICK JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:JAMES
Last Name:GORDON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:22 OLD SHORT HILLS RD
Mailing Address - Street 2:STE 102
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-5605
Mailing Address - Country:US
Mailing Address - Phone:973-533-1050
Mailing Address - Fax:973-533-1235
Practice Address - Street 1:22 OLD SHORT HILLS RD
Practice Address - Street 2:STE 102
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-5605
Practice Address - Country:US
Practice Address - Phone:973-533-1050
Practice Address - Fax:973-533-1235
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA02379500207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
D19584Medicare UPIN