Provider Demographics
NPI:1245495795
Name:GORDON, ELISABETH GROOME (MD)
Entity type:Individual
Prefix:DR
First Name:ELISABETH
Middle Name:GROOME
Last Name:GORDON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E 72ND ST
Mailing Address - Street 2:APT. 21G
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4537
Mailing Address - Country:US
Mailing Address - Phone:917-655-1669
Mailing Address - Fax:212-861-1771
Practice Address - Street 1:200 E 72ND ST
Practice Address - Street 2:APT. 21G
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4537
Practice Address - Country:US
Practice Address - Phone:917-655-1669
Practice Address - Fax:212-861-1771
Is Sole Proprietor?:No
Enumeration Date:2008-07-24
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program