Provider Demographics
NPI:1801829734
Name:GORDON, STEPHEN JAY (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:JAY
Last Name:GORDON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:317 CLEVELAND AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08904-1817
Mailing Address - Country:US
Mailing Address - Phone:732-545-0362
Mailing Address - Fax:732-545-7499
Practice Address - Street 1:317 CLEVELAND AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:HIGHLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:08904-1817
Practice Address - Country:US
Practice Address - Phone:732-545-0362
Practice Address - Fax:732-545-7499
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA04275700207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC10081Medicare UPIN