Provider Demographics
NPI:1295408086
Name:GORDON, RONIQUE CARELLE (MBBS)
Entity Type:Individual
Prefix:DR
First Name:RONIQUE
Middle Name:CARELLE
Last Name:GORDON
Suffix:
Gender:F
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20911 41ST AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11361-1926
Mailing Address - Country:US
Mailing Address - Phone:929-278-2988
Mailing Address - Fax:
Practice Address - Street 1:20911 41ST AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11361-1926
Practice Address - Country:US
Practice Address - Phone:929-278-2988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-27
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program