Provider Demographics
NPI:1770800310
Name:GORDON, JEFFREY J (MAC)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:J
Last Name:GORDON
Suffix:
Gender:M
Credentials:MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 DOREEN ST
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-4440
Mailing Address - Country:US
Mailing Address - Phone:413-442-9672
Mailing Address - Fax:
Practice Address - Street 1:1 WEST ST
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-6298
Practice Address - Country:US
Practice Address - Phone:413-445-5600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-21
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01655171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist