Individual
AVION GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
127 MAPLE LN, MEDFORD, NY 11763-1027
(631) 605-1986
Mailing address
127 MAPLE LN, MEDFORD, NY 11763-1027
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
286841-1
NY
Other
Enumeration date
09/30/2009
Last updated
09/30/2009
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