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Organization
STATEN ISLAND MEDICAL PROFESSIONAL PC
Active
Organization
STATEN ISLAND MEDICAL PROFESSIONAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EDWIN BARRY GORDON M.D (OWNER)
(718) 356-0207
Entity
Organization
Contact information
Practice address
5405 HYLAN BLVD, STATEN ISLAND, NY 10312-5241
(718) 356-0207
Mailing address
5405 HYLAN BLVD, STATEN ISLAND, NY 10312-5241
(718) 356-0207
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
097198
NY
Other
Enumeration date
01/18/2011
Last updated
01/18/2011
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