Provider Demographics
NPI:1356667935
Name:GORDON, TAMIKA
Entity Type:Individual
Prefix:
First Name:TAMIKA
Middle Name:
Last Name:GORDON
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 1:9131 QUEENS BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-5501
Mailing Address - Country:US
Mailing Address - Phone:718-281-8799
Mailing Address - Fax:516-570-4099
Practice Address - Street 1:9131 QUEENS BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-5501
Practice Address - Country:US
Practice Address - Phone:718-281-8799
Practice Address - Fax:516-570-4099
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-08
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY277332164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse