Individual
DR. DUSTIN JOEL GORDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
61 N. MAPLE AVE., STE 103, RIDGWOOD, NJ 07450
(201) 670-9773
(973) 427-1463
Mailing address
61 N. MAPLE AVE., STE 103, RIDGWOOD, NJ 07450
(201) 670-9773
(973) 427-1463
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
3610
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7469028
—
NJ
Enumeration date
09/20/2006
Last updated
07/08/2007
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