Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 203705 | NY |
NPI | 1154316230 |
---|---|
Provider Name | Peter Eliot Gordon |
First Address | Brooklyn, NY 11201-6620 |
Second Address | Brooklyn, NY 11201-6620 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2005 |
Last Update Date | 06/04/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G31739 | (02) | NY |