Provider Demographics
NPI:1437304011
Name:GORDON, INA (OCCUPATIONAL THERAPI)
Entity Type:Individual
Prefix:MRS
First Name:INA
Middle Name:
Last Name:GORDON
Suffix:
Gender:F
Credentials:OCCUPATIONAL THERAPI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67-14 108 STREET #3E
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375
Mailing Address - Country:US
Mailing Address - Phone:718-897-1507
Mailing Address - Fax:718-838-8152
Practice Address - Street 1:333 PARK AVE S
Practice Address - Street 2:
Practice Address - City:NY
Practice Address - State:NY
Practice Address - Zip Code:10010
Practice Address - Country:US
Practice Address - Phone:212-388-1903
Practice Address - Fax:718-838-8152
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-24
Last Update Date:2009-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY06303-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant