Provider Demographics
NPI:1518338946
Name:GORDON, RUTHMAE
Entity Type:Individual
Prefix:
First Name:RUTHMAE
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 1:369 UTICA AVE
Mailing Address - Street 2:2ND FLR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11213-5552
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:369 UTICA AVE
Practice Address - Street 2:2ND FLR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213-5552
Practice Address - Country:US
Practice Address - Phone:917-202-3783
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-12
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY315392164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse