Provider Demographics
NPI:1326049529
Name:GORDON, CHARLES RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:RICHARD
Last Name:GORDON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:200 CABRINI BLVD
Mailing Address - Street 2:SUITE 17
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-1100
Mailing Address - Country:US
Mailing Address - Phone:212-928-0555
Mailing Address - Fax:212-740-2934
Practice Address - Street 1:200 CABRINI BLVD
Practice Address - Street 2:SUITE 17
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-1100
Practice Address - Country:US
Practice Address - Phone:212-928-0555
Practice Address - Fax:212-740-2934
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY140363207QA0000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent Medicine
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics