Individual
RANDALL GORDON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
30 PARK AVE APT 1L, MOUNT VERNON, NY 10550-2151
(347) 341-9334
Mailing address
30 PARK AVE APT 1L, MOUNT VERNON, NY 10550-2151
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
—
NY
3747P1801X
Personal Care Attendant
—
NY
Other
Enumeration date
05/04/2023
Last updated
05/04/2023
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