Provider Demographics
NPI:1730106352
Name:GORDON, RICHARD E (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:E
Last Name:GORDON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4271 HEMPSTEAD TPKE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11714
Mailing Address - Country:US
Mailing Address - Phone:516-796-3700
Mailing Address - Fax:516-796-3205
Practice Address - Street 1:4271 HEMPSTEAD TPKE
Practice Address - Street 2:SUITE 1
Practice Address - City:BETHPAGE
Practice Address - State:NY
Practice Address - Zip Code:11714
Practice Address - Country:US
Practice Address - Phone:516-796-3700
Practice Address - Fax:516-796-3205
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY147478207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00895616Medicaid
NY00895616Medicaid
NY45D68Medicare ID - Type Unspecified