Provider Demographics
NPI:1285230722
Name:LESLIE E. GORDON, MD P.C.
Entity Type:Organization
Organization Name:LESLIE E. GORDON, MD P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-531-0197
Mailing Address - Street 1:2600 NETHERLAND AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-4813
Mailing Address - Country:US
Mailing Address - Phone:718-709-0955
Mailing Address - Fax:
Practice Address - Street 1:2600 NETHERLAND AVE STE 102
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-4813
Practice Address - Country:US
Practice Address - Phone:718-709-0955
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-09
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0120XAllopathic & Osteopathic PhysiciansOphthalmologyCornea and External Diseases SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6922512OtherCIGNA
NYP3908626OtherOXFORD
NY1104038231OtherEMPIRE BCBS
NY112358021Other1199
NY408107OtherGHI
NY9123112OtherAETNA