Organization
MIRIAM GORDON PEDIATRIC NP PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MIRIAM GORDON NP (COO)
(718) 815-1000
Entity
Organization
Contact information
Practice address
6010 BAY PKWY FL 9, BROOKLYN, NY 11204-6079
(718) 238-2100
(718) 815-8122
Mailing address
302 MANOR RD, STATEN ISLAND, NY 10314-2408
(718) 815-1000
(718) 815-8122
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
381940
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02460364
—
NY
Enumeration date
04/16/2015
Last updated
04/16/2015
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