Provider Demographics
NPI:1831480938
Name:MURRAY A. GORDON, MDPC
Entity type:Organization
Organization Name:MURRAY A. GORDON, MDPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MURRAY
Authorized Official - Middle Name:A
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-799-4061
Mailing Address - Street 1:390 W END AVE
Mailing Address - Street 2:SUITE 6E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-6107
Mailing Address - Country:US
Mailing Address - Phone:212-799-4061
Mailing Address - Fax:212-799-4061
Practice Address - Street 1:390 W END AVE APT 6E
Practice Address - Street 2:SUITE 6E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-6107
Practice Address - Country:US
Practice Address - Phone:212-799-4061
Practice Address - Fax:212-799-4061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-22
Last Update Date:2011-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY110109-12084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC11832Medicare UPIN