Provider Demographics
NPI:1275862138
Name:ALAN S GORDON EDD.PA
Entity Type:Organization
Organization Name:ALAN S GORDON EDD.PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:609-799-3866
Mailing Address - Street 1:196 PRINCETON HIGHTSTOWN RD
Mailing Address - Street 2:BUILDING 1 2ND FLOOR
Mailing Address - City:PRINCETON JUNCTION
Mailing Address - State:NJ
Mailing Address - Zip Code:08550-1672
Mailing Address - Country:US
Mailing Address - Phone:609-799-3866
Mailing Address - Fax:609-799-7930
Practice Address - Street 1:196 PRINCETON HIGHTSTOWN RD
Practice Address - Street 2:BUILDING 1 2ND FLOOR
Practice Address - City:PRINCETON JUNCTION
Practice Address - State:NJ
Practice Address - Zip Code:08550-1672
Practice Address - Country:US
Practice Address - Phone:609-799-3866
Practice Address - Fax:609-799-7930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-23
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100100000103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty