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Individual

DR. LANCE STEWART GORDON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DO

Contact information

Practice address
1 HEALTHY WAY, OCEANSIDE, NY 11572-1551
(516) 632-4191
(516) 632-4195
Mailing address
68 S SERVICE RD, SUITE 350, MELVILLE, NY 11747-2354
(516) 945-3107
(516) 945-3131

Taxonomy

Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
258288
NY
207L00000X
Anesthesiology Physician
Primary
OS9740
FL
207LP3000X
Pediatric Anesthesiology Physician
OS9740
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0002109-00
FL
05
317169747A
GA
01
A400055931
MEDICARE
NY
Enumeration date
07/01/2008
Last updated
06/06/2012
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