Provider Demographics
NPI:1558588988
Name:GORDON, JOSHUA A (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:A
Last Name:GORDON
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 W 79TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-6449
Mailing Address - Country:US
Mailing Address - Phone:646-554-7169
Mailing Address - Fax:212-543-1174
Practice Address - Street 1:171 W 79TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-6449
Practice Address - Country:US
Practice Address - Phone:646-554-7169
Practice Address - Fax:212-543-1174
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2110792084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH40798Medicare UPIN