Provider Demographics
NPI:1649532268
Name:GORDON, YEKATERINA (MD)
Entity type:Individual
Prefix:MRS
First Name:YEKATERINA
Middle Name:
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 1:99 BATTERY PL
Mailing Address - Street 2:APT 18H
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10280-1320
Mailing Address - Country:US
Mailing Address - Phone:917-355-1652
Mailing Address - Fax:
Practice Address - Street 1:99 BATTERY PL
Practice Address - Street 2:18H
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10280-1320
Practice Address - Country:US
Practice Address - Phone:917-355-1652
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-10
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY282705207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program