Provider Demographics
NPI:1275765661
Name:GORDON-PATTERSON, INGRID
Entity Type:Individual
Prefix:
First Name:INGRID
Middle Name:
Last Name:GORDON-PATTERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 HORSEBLOCK RD
Mailing Address - Street 2:STE H
Mailing Address - City:FARMINGVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11738-1252
Mailing Address - Country:US
Mailing Address - Phone:631-451-2211
Mailing Address - Fax:631-451-1463
Practice Address - Street 1:400 HORSEBLOCK RD
Practice Address - Street 2:STE H
Practice Address - City:FARMINGVILLE
Practice Address - State:NY
Practice Address - Zip Code:11738-1252
Practice Address - Country:US
Practice Address - Phone:631-451-2211
Practice Address - Fax:631-451-1463
Is Sole Proprietor?:No
Enumeration Date:2009-08-18
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY305202363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health