Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 25MA08373200 | NJ |
N | 207W00000X | Ophthalmologist | MD441470 | PA |
NPI | 1003034034 |
---|---|
Provider Name | Dr. Susan Master Gordon |
First Address | Voorhees, NJ 08043-2106 |
Second Address | Voorhees, NJ 08043-2106 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2007 |
Last Update Date | 24/10/2017 |