Provider Demographics
NPI:1467099713
Name:GORDON, LEMAR ANTHONY (LPN)
Entity Type:Individual
Prefix:
First Name:LEMAR
Middle Name:ANTHONY
Last Name:GORDON
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 S BLEEKER ST APT 1
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10550-2629
Mailing Address - Country:US
Mailing Address - Phone:929-227-1052
Mailing Address - Fax:929-227-1052
Practice Address - Street 1:41 S BLEEKER ST APT 1
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-2629
Practice Address - Country:US
Practice Address - Phone:929-227-1052
Practice Address - Fax:929-227-1052
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-05
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY337299164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty