Provider Demographics
NPI:1013904333
Name:GORDON, MICHAEL S (MD)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:S
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:PO BOX 10439
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08650-4039
Mailing Address - Country:US
Mailing Address - Phone:609-581-5303
Mailing Address - Fax:609-631-6839
Practice Address - Street 1:2119 HIGHWAY 33
Practice Address - Street 2:SUITE B
Practice Address - City:HAMILTON SQUARE
Practice Address - State:NJ
Practice Address - Zip Code:08690-1740
Practice Address - Country:US
Practice Address - Phone:609-581-5303
Practice Address - Fax:609-631-6839
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-03
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05912000207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ050071446OtherRAIL ROAD MEDICARE
NJ5531802Medicaid
NJ0658805000OtherAMERIHEALTH PRODUCTS
NJ1097352OtherHORIZON MERCY
F60016Medicare UPIN
022687M5FMedicare ID - Type Unspecified