Individual
MR. CHARLES GORDON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
315 S MANNING BLVD, ALBANY, NY 12208-1707
(518) 252-1550
Mailing address
PO BOX 14890, ALBANY, NY 12212-4890
(518) 525-5634
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
019257
NY
Other
Enumeration date
12/18/2015
Last updated
05/20/2021
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