Provider Demographics
NPI:1588023543
Name:GORDON, NIRIT (MA)
Entity Type:Individual
Prefix:
First Name:NIRIT
Middle Name:
Last Name:GORDON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 SAINT MARKS AVE
Mailing Address - Street 2:APT 5D
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-7439
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:521 SAINT MARKS AVE
Practice Address - Street 2:APT 5D
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-7439
Practice Address - Country:US
Practice Address - Phone:917-605-0016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-18
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program