Provider Demographics
NPI:1619620457
Name:BRUCE LEWIS GORDON MD PC
Entity Type:Organization
Organization Name:BRUCE LEWIS GORDON MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-820-0000
Mailing Address - Street 1:1 BYRAM BROOK PL
Mailing Address - Street 2:
Mailing Address - City:ARMONK
Mailing Address - State:NY
Mailing Address - Zip Code:10504-2316
Mailing Address - Country:US
Mailing Address - Phone:914-820-0000
Mailing Address - Fax:
Practice Address - Street 1:1 BYRAM BROOK PL
Practice Address - Street 2:
Practice Address - City:ARMONK
Practice Address - State:NY
Practice Address - Zip Code:10504-2316
Practice Address - Country:US
Practice Address - Phone:914-820-0000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-01
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty