Provider Demographics
NPI:1437590999
Name:GORDON, BRIGITTE L (RN)
Entity Type:Individual
Prefix:MS
First Name:BRIGITTE
Middle Name:L
Last Name:GORDON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 CRYSTAL RUN RD STE 135
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10941-7009
Mailing Address - Country:US
Mailing Address - Phone:845-333-7800
Mailing Address - Fax:
Practice Address - Street 1:75 CRYSTAL RUN RD STE 135
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10941
Practice Address - Country:US
Practice Address - Phone:845-333-7800
Practice Address - Fax:845-333-7696
Is Sole Proprietor?:No
Enumeration Date:2013-07-12
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY659845-1163WP0809X
NY40 401775363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04276486Medicaid