Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | 25MBO3186400 | NJ |
NPI | 1013945799 |
---|---|
Provider Name | Dr. Robert Gordon |
First Address | Stratford, NJ 08084-1354 |
Second Address | Stratford, NJ 08084-1354 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2006 |
Last Update Date | 06/02/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1996509 | (05) | NJ |
290008695 | RAILROAD MEDICARE (01) | NJ |
E79641 | (02) | NJ |