Provider Demographics
NPI:1639132202
Name:GORDON, BARBARA FAITH
Entity Type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:FAITH
Last Name:GORDON
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:BARBARA
Other - Middle Name:F
Other - Last Name:GORDON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1854 BEDFORD AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11225-5006
Mailing Address - Country:US
Mailing Address - Phone:718-462-0018
Mailing Address - Fax:718-462-0061
Practice Address - Street 1:1854 BEDFORD AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225-5006
Practice Address - Country:US
Practice Address - Phone:718-462-0018
Practice Address - Fax:718-462-0061
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-06
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY203809174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01896991Medicaid
NY01896991Medicaid
NYG89127Medicare UPIN