Provider Demographics
NPI:1396036372
Name:MARK GORDON, MD, PC
Entity Type:Organization
Organization Name:MARK GORDON, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:S
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-684-5884
Mailing Address - Street 1:2 LONGVIEW AVE
Mailing Address - Street 2:STE 302
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10601-5000
Mailing Address - Country:US
Mailing Address - Phone:914-684-5884
Mailing Address - Fax:914-684-6178
Practice Address - Street 1:2 LONGVIEW AVE
Practice Address - Street 2:STE 302
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-5000
Practice Address - Country:US
Practice Address - Phone:914-684-5884
Practice Address - Fax:914-684-6178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-26
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY155799174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty