Provider Demographics
NPI:1932462322
Name:GORDON, CELESTE VERONICA
Entity Type:Individual
Prefix:MS
First Name:CELESTE
Middle Name:VERONICA
Last Name:GORDON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 LASALLE STREET
Mailing Address - Street 2:APT. 3E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-4705
Mailing Address - Country:US
Mailing Address - Phone:212-666-3599
Mailing Address - Fax:212-666-3599
Practice Address - Street 1:70 LASALLE STREET
Practice Address - Street 2:APT. 3E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-4705
Practice Address - Country:US
Practice Address - Phone:212-666-3599
Practice Address - Fax:212-666-3599
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-20
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist