Provider Demographics
NPI:1609322619
Name:GORDIUM MEDICAL SERVICES
Entity Type:Organization
Organization Name:GORDIUM MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIANS ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:ARPANA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIVDASANI
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:561-562-0674
Mailing Address - Street 1:4723 W ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-3895
Mailing Address - Country:US
Mailing Address - Phone:561-562-0674
Mailing Address - Fax:561-265-5673
Practice Address - Street 1:4723 W ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-3895
Practice Address - Country:US
Practice Address - Phone:561-562-0674
Practice Address - Fax:561-265-5673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-30
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care