Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | F306859-1 | NY |
NPI | 1013302959 |
---|---|
Provider Name | Mrs. Oxana Gordon |
First Address | Brooklyn, NY 11234-5886 |
Second Address | Brooklyn, NY 11235-8440 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2015 |
Last Update Date | 30/03/2015 |