Provider Demographics
NPI:1922300375
Name:GORDON P. TUSSING, D.O., P.C.
Entity Type:Organization
Organization Name:GORDON P. TUSSING, D.O., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:P
Authorized Official - Last Name:TUSSING
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:716-839-9113
Mailing Address - Street 1:4643 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SNYDER
Mailing Address - State:NY
Mailing Address - Zip Code:14226-4551
Mailing Address - Country:US
Mailing Address - Phone:716-839-9113
Mailing Address - Fax:716-839-3771
Practice Address - Street 1:4643 MAIN ST
Practice Address - Street 2:
Practice Address - City:SNYDER
Practice Address - State:NY
Practice Address - Zip Code:14226-4551
Practice Address - Country:US
Practice Address - Phone:716-839-9113
Practice Address - Fax:716-839-3771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-17
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY212802207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCC0924Medicare UPIN