Provider Demographics
NPI:1912936162
Name:DONALD, GORDON D III (MD)
Entity Type:Individual
Prefix:DR
First Name:GORDON
Middle Name:D
Last Name:DONALD
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:234 INDUSTRIAL WAY W
Mailing Address - Street 2:BUILDING A SUITE 200
Mailing Address - City:EATONTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-4244
Mailing Address - Country:US
Mailing Address - Phone:732-747-7110
Mailing Address - Fax:732-747-7664
Practice Address - Street 1:234 INDUSTRIAL WAY W
Practice Address - Street 2:SUITE A200
Practice Address - City:EATONTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07724-4244
Practice Address - Country:US
Practice Address - Phone:732-747-7110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA46751207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJE74083Medicare UPIN
NJ059331RKPMedicare ID - Type UnspecifiedNORTH JERSEY
NJ059331SLKMedicare ID - Type UnspecifiedSOUTH JERSEY