Provider Demographics
NPI:1922772797
Name:GORDON, DOREEN E (RN)
Entity Type:Individual
Prefix:MS
First Name:DOREEN
Middle Name:E
Last Name:GORDON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1818 NEREID AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-1224
Mailing Address - Country:US
Mailing Address - Phone:386-898-8320
Mailing Address - Fax:
Practice Address - Street 1:13802 QUEENS BLVD
Practice Address - Street 2:
Practice Address - City:BRIARWOOD
Practice Address - State:NY
Practice Address - Zip Code:11435-2665
Practice Address - Country:US
Practice Address - Phone:718-206-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-05
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY769967163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse